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Guan X, Chen D, Xu Y. Clinical practice guidelines for nutritional assessment and monitoring of adult ICU patients in China. JOURNAL OF INTENSIVE MEDICINE 2024; 4:137-159. [PMID: 38681796 PMCID: PMC11043647 DOI: 10.1016/j.jointm.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 05/01/2024]
Abstract
The Chinese Society of Critical Care Medicine (CSCCM) has developed clinical practice guidelines for nutrition assessment and monitoring for patients in adult intensive care units (ICUs) in China. This guideline focuses on nutrition evaluation and metabolic monitoring to achieve optimal and personalized nutrition therapy for critically ill patients. This guideline was developed by experts in critical care medicine and evidence-based medicine methodology and was developed after a thorough review of the system and a summary of relevant trials or studies published from 2000 to July 2023. A total of 18 recommendations were formed and consensus was reached through discussions and reviews by expert groups in critical care medicine, parenteral and enteral nutrition, and surgery. The recommendations are based on currently available evidence and cover several key fields, including screening and assessment, evaluation and assessment of enteral feeding intolerance, metabolic and nutritional measurement and monitoring during nutrition therapy, and organ function evaluation related to nutrition supply. Each question was analyzed according to the Population, Intervention, Comparison, and Outcome (PICO) principle. In addition, interpretations were provided for four questions that did not reach a consensus but may have potential clinical and research value. The plan is to update this nutrition assessment and monitoring guideline using the international guideline update method within 3-5 years.
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Affiliation(s)
- Xiangdong Guan
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dechang Chen
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Xu
- Department of Critical Care Medicine, Beijing Tsinghua Changgung Hospital, Beijing, China
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Peng F, Wang H, Li J, Ma M, Jiang X, Run H, Li Q, Leng J, Xiao L, Tang L. Best evidence summary for prevention and management of enteral feeding intolerance in critically ill patients. J Clin Nurs 2024; 33:781-796. [PMID: 37994227 DOI: 10.1111/jocn.16934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/17/2023] [Accepted: 10/18/2023] [Indexed: 11/24/2023]
Abstract
AIM To evaluate and summarize the evidence for prevention and management of enteral feeding intolerance in critically ill patients and provide reference for clinical practice. DESIGN This study was an evidence summary followed by the evidence summary reporting standard of Fudan University Center for Evidence-based Nursing. METHODS Current literatures were systematically searched for the best evidence for prevention and management of enteral feeding intolerance in critically ill patients. Literature types included clinical guidelines, best practice information sheets, expert consensuses, systematic reviews, evidence summaries and cohort studies. DATA SOURCES UpToDate, BMJ Best Practice, Joanna Briggs Institute, Guidelines International Network, National Institute for Health and Care Excellence, Registered Nurses Association of Ontario, Scottish Intercollegiate Guidelines Network, the Cochrane Library, Embase, PubMed, Sinomed, Web of Science, Yi Maitong Guidelines Network, DynaMed, MEDLINE, CNKI, WanFang database, Chinese Medical Journal Full-text Database, European Society for Clinical Nutrition and Metabolism website, the American Society for Parenteral and Enteral Nutrition website were searched from January 2012 to April 2023. RESULTS We finally identified 18 articles that had high-quality results. We summarized the 24 pieces of best evidence from these articles, covering five aspects: screening and assessment of the risk of enteral nutritional tolerance; formulation of enteral nutrition preparations; enteral nutritional feeding implementation; feeding intolerance symptom prevention and management; and multidisciplinary management. Of these pieces of evidence, 19 were 'strong' and 5 were 'weak', 7 pieces of evidence were recommended in level one and 4 pieces of evidence were recommended in level two. CONCLUSION The following 24 pieces of evidence for prevention and management of enteral feeding intolerance in critically ill patients were finally recommended. However, as these evidences came from different countries, relevant factors such as the clinical environment should be evaluated before application. Future studies should focus on more specific symptoms of feeding intolerance and more targeted prevention design applications. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE The clinical medical staffs are recommended to take evidence-based recommendations for the implementation of standardized enteral nutrition to improve patient outcomes and decrease gastrointestinal intolerance in critically ill patients. IMPACT The management of enteral nutrition feeding intolerance has always been a challenge and difficulty in critically ill patients. This study summarizes 24 pieces of the best evidence for prevention and management of enteral nutrition feeding intolerance in critically ill patients. Following and implementing these 24 pieces of evidence is beneficial to the prevention and management of feeding intolerance in clinical practice. The 24 pieces of evidence include five aspects, including screening and assessment of the risk of enteral nutritional tolerance, formulation of enteral nutrition preparations, enteral nutritional feeding implementation, feeding intolerance symptom prevention and management and multidisciplinary management. These five aspects constitute a good implementation process. Screening and assessment of enteral nutritional tolerance throughout intervention are important guarantees for developing a feasible nutrition program in critically ill patients. This study will be benefit to global medical workers in the nutritional management of critically ill patients. REPORTING METHOD This evidence summary followed the evidence summary reporting specifications of Fudan University Center for Evidence-based Nursing, which were based on the methodological process for the summary of the evidence produced by the Joanna Briggs Institute (JBI). The reporting specifications include problem establishment, literature retrieval, literature screening, literature evaluation, the summary and grading of evidence and the formation of practical suggestions. This study was based on the evidence summary reporting specifications of the Fudan University Center for the Evidence-based Nursing, the register name is 'Best evidence summary for prevention and management of enteral feeding intolerance in critically ill patients', the registration number is 'ES20231823'.
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Affiliation(s)
- Fang Peng
- School of Nursing, University of South China, Hunan, P.R. China
- Department of Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Huaqin Wang
- Department of Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Jianzhi Li
- School of Nursing, University of South China, Hunan, P.R. China
| | - Mengqi Ma
- School of Nursing, University of South China, Hunan, P.R. China
| | - Xuemeng Jiang
- School of Nursing, University of South China, Hunan, P.R. China
| | - Han Run
- School of Nursing, University of South China, Hunan, P.R. China
| | - Qingting Li
- Department of Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Juanjuan Leng
- School of Nursing, University of South China, Hunan, P.R. China
| | - Luwei Xiao
- School of Nursing, University of South China, Hunan, P.R. China
| | - Li Tang
- Department of Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
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Martinez J, Rodriguez Hovnanian KM, Martinez EE. Biomarkers and Functional Assays of Epithelial Barrier Disruption and Gastrointestinal Dysmotility in Critical Illness-A Narrative Review. Nutrients 2023; 15:4052. [PMID: 37764835 PMCID: PMC10535972 DOI: 10.3390/nu15184052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
Enteral nutrition in critically ill children has been associated with improved clinical outcomes. Gastrointestinal dysfunction often impedes the timely initiation and advancement of enteral nutrition and can contribute to immune dysregulation and systemic inflammation. Therefore, assessing gastrointestinal function, at a cellular and functional level, is important to provide optimal enteral nutrition therapy and reduce the gastrointestinal tract's contribution to the inflammatory cascade of critical illness. In this narrative review, we present an overview of biomarker and functional assays for gastrointestinal dysfunction, including epithelial barrier disruption and gastrointestinal dysmotility, that have been considered for critically ill patients.
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Affiliation(s)
- Julianna Martinez
- Rutgers, Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA;
| | - K. Marco Rodriguez Hovnanian
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA 02129, USA;
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Enid E. Martinez
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA 02129, USA;
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA
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Xu XY, Xue HP, Yuan MJ, Jin YR, Huang CX. Effects of ultrasound monitoring of gastric residual volume on feeding complications, caloric intake and prognosis of patients with severe mechanical ventilation. World J Gastrointest Surg 2023; 15:1719-1727. [PMID: 37701696 PMCID: PMC10494589 DOI: 10.4240/wjgs.v15.i8.1719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/08/2023] [Accepted: 06/19/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Monitoring of gastric residual is an important approach for assessing gastric emptying in patients with mechanical ventilation. By monitoring gastric contents, the enteral nutrition scheme can be adjusted in time to ensure feeding safety.
AIM To investigate the effects of ultrasound monitoring on the incidence of feeding complications, daily caloric intake and prognosis of patients with severe mechanical ventilation. To analyze the clinical significance of ultrasound monitoring of gastric residual volume (GRV) up to 250 mL to provide a theoretical basis for clinical practice.
METHODS Patients admitted to the department of emergency medicine of the Affiliated Hospital of Nantong University from January 2018 to June 2022 who received invasive mechanical ventilation and continuous enteral nutrition support within 24-48 h after admission were enrolled in this study. Medical records for patients within 7 d of hospitalization were retrospectively analyzed to compare the incidence of feeding complications, daily caloric intake and clinical prognosis between patients with gastric residual ≥ 250 mL and < 250 mL, as monitored by ultrasound on the third day.
RESULTS A total of 513 patients were enrolled in this study. Incidences of abdominal distension, diarrhea, and vomiting in the < 250 mL and ≥ 250 mL groups were: 18.4% vs 21.0%, 23.9% vs 32.3% and 4.0% vs 6.5%, respectively; mortality rates were 20.8% vs 22.65%; mechanical ventilation durations were 18.30 d vs 17.56 d while lengths of stay in the intensive care units (ICU) were 19.87 d vs 19.19 ± 5.19 d. Differences in the above factors between groups were not significant. Gastric residual ≥ 250 mL was not an independent risk factor for death and prolonged ICU stay. However, target feeding time of patients in the ≥ 250 mL group was longer than that of patients in the ≥ 250 mL group, and caloric intake (22.0, 23.6, 24.8, 25.3 kcal/kg/d) for patients in the ≥ 250 mL group from the 4th day to the 7th day of hospitalization was lower than that of patients in the ≥ 250 mL group (23.2, 24.8, 25.7, 25.8 kcal/kg/d). On the 4th day (Z = 4.324, P = 0.013), on the 5th day (Z = 3.376, P = 0.033), while on the 6th day (Z = 3.098, P = 0.04), the differences were statistically significant.
CONCLUSION The use of ultrasound to monitor GRV and undertaking clinical interventions when the monitoring value is ≥ 250 mL has no significant effects on incidences of feeding complications and clinical prognostic outcomes, however, it significantly prolongs the time to reach target feeding, reduces the daily intake of calories during ICU hospitalization, and increases the risk of insufficient nutrition of patients. The accuracy and necessity of monitoring gastric remnants and monitoring frequencies should be investigated further.
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Affiliation(s)
- Xiao-Yan Xu
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Hui-Ping Xue
- Emergency Medical Intensive Care Unit, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Ming-Jun Yuan
- Emergency Medical Intensive Care Unit, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - You-Rong Jin
- Emergency Medical Intensive Care Unit, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Chun-Xia Huang
- Department of Emergency Outpatient, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
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Li J, Wang L, Zhang H, Zou T, Kang Y, He W, Xu Y, Yin W. Different definitions of feeding intolerance and their associations with outcomes of critically ill adults receiving enteral nutrition: a systematic review and meta-analysis. J Intensive Care 2023; 11:29. [PMID: 37408020 DOI: 10.1186/s40560-023-00674-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/04/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND A unified clinical definition of feeding intolerance (FI) is urged for better management of enteral nutrition (EN) in critically ill patients. We aimed to identify optimum clinical FI definitions based on reported evidence. METHODS We searched clinical studies comparing FI with non-FI with a clear definition, summarized the evidence by random-effect meta-analyses, and rated the certainty of evidence by the Grading of Recommendations Assessment, Development and Evaluation frameworks. RESULTS Five thousand five hundred twenty-five records were identified, of which 26 eligible studies enrolled 25,189 adult patients. Most patient-centered outcomes were associated with FI overall. Low to very low certainty evidence established FI defined as large gastric residual volume (GRV) ≥ 250 ± 50 mL combined with any other gastrointestinal symptoms (GIS) had a significant association with high mortalities in particular all-cause hospital mortality (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.40-2.57), the incidence of pneumonia (OR 1.54, 95% CI 1.13-2.09) and prolonged length of hospital stay (mean difference 4.20, 95% CI 2.08-6.32), with a moderate hospital prevalence (41.49%, 95% CI 31.61-51.38%). 3-day enteral feeding (EF) delivered percentage < 80% had a moderate hospital prevalence (38.23%, 95% CI 24.88-51.58) but a marginally significant association with all-cause hospital mortality (OR 1.90, 95% CI 1.03-3.50). CONCLUSIONS In critically ill adult patients receiving EN, the large-GRV-centered GIS to define FI seemed to be superior to 3-day EF-insufficiency in terms of both close associations with all-cause hospital mortality and acceptable hospital prevalence (Registered PROSPERO: CRD42022326273). TRIAL REGISTRATION The protocol for this review and meta-analysis was registered with PROSPERO: CRD42022326273. Registered 10 May 2022.
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Affiliation(s)
- Jianbo Li
- Department of Critical Care Medicine, West China Hospital of Sichuan University, 37 Guo Xue Xiang St., Chengdu, 610041, Sichuan, China
| | - Lijie Wang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, 37 Guo Xue Xiang St., Chengdu, 610041, Sichuan, China
| | - Huan Zhang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, 37 Guo Xue Xiang St., Chengdu, 610041, Sichuan, China
| | - Tongjuan Zou
- Department of Critical Care Medicine, West China Hospital of Sichuan University, 37 Guo Xue Xiang St., Chengdu, 610041, Sichuan, China
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, 37 Guo Xue Xiang St., Chengdu, 610041, Sichuan, China
| | - Wei He
- Department of Critical Care Medicine, Beijing Tongren Hospital of Capital Medical University, Beijing, 100730, China
| | - Yuan Xu
- Department of Critical Care Medicine, Beijing Tsinghua Chunggung Hospital, Tsinghua University, 168 Litang Rd., Beijing, 102218, China.
| | - Wanhong Yin
- Department of Critical Care Medicine, West China Hospital of Sichuan University, 37 Guo Xue Xiang St., Chengdu, 610041, Sichuan, China.
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Liu X, Wang Q, Yang D, Fu M, Yang M, Bi Y, Wang C, Song X. Association between Gastrointestinal Dysfunction Score (GIDS) and disease severity and prognosis in critically ill patients: A prospective, observational study. Clin Nutr 2023; 42:700-705. [PMID: 36958226 DOI: 10.1016/j.clnu.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVES Recently, the Gastrointestinal Dysfunction Score (GIDS) was developed for use with critically ill patients. This study evaluated the association of GIDS with disease severity and clinical outcomes to assess the technical feasibility of using GIDS to reflect the severity and short-term prognosis of critically ill patients. METHODS Association between Gastrointestinal Dysfunction Score (GIDS) and disease severity and prognosis in critically ill patients: A prospective, observational study. This was a prospective observational study involving adult patients in two Intensive Care Units (ICUs). During the first seven days of ICU admission, GIDS, acute gastrointestinal injury (AGI), Acute Physiology and Chronic Health Evaluation II (APACHE II), and Sequential Organ Failure Assessment (SOFA) scores were assessed daily. RESULTS A total of 276 patients from two centers were enrolled in this study. Patients were divided into GIDS 0-1 (121, 43.8%) and GIDS 2-4 (155, 56.2%). The ICU length of stay and 28-day mortality in the GIDS 2-4 group were significantly higher than the GIDS 0-1 group (P = 0.032, P = 0.001, respectively). The APACHE II and SOFA scores in the GIDS 2-4 group were also significantly higher (P < 0.001). The ROC curves of GIDS, AGI, APACHE II, and SOFA scores on the first day of ICU admission for the prediction of 28-day mortality showed that the AUC of GIDS was 0.702 (95%CI 0.628, 0.775; P < 0.001). The AUC for GIDS + SOFA was 0.719 (95%CI 0.648, 0.790; P < 0.001), compared with SOFA alone (AUC = 0.703), showing improved predictive power for 28-day mortality. CONCLUSIONS GIDS represents a step toward a reliable clinical tool for GI dysfunction to assess disease severity and short-term prognosis in critically ill patients. In addition, combining GIDS with SOFA score may better predict mortality risk compared to SOFA score alone.
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Affiliation(s)
- Xinyan Liu
- ICU, Dong E Hospital, Liaocheng, Shandong, China
| | - Qizhi Wang
- ICU, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China
| | - Daqiang Yang
- ICU, Dong E Hospital, Liaocheng, Shandong, China
| | - Maoliang Fu
- ICU, Dong E Hospital, Liaocheng, Shandong, China
| | - Maopeng Yang
- ICU, Dong E Hospital, Liaocheng, Shandong, China
| | - Yang Bi
- Intensive Care Medicine, Shandong First Medical University, Jinan, Shandong, China
| | - Chunting Wang
- ICU, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China
| | - Xuan Song
- ICU, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China; Shandong Institute of Endocrine & Metabolic Diseases Affiliated to Shandong First Medical University, Jinan, Shandong, China.
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Bourgault AM, Deb C, Aguirre L, Xie R, Rathbun KP, Sole ML. Microbiome profile informs cleansing and storage practices for reusable feeding tube stylets in critical care. Nutr Clin Pract 2023; 38:411-424. [PMID: 35985807 DOI: 10.1002/ncp.10904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/13/2022] [Accepted: 07/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cleansing and storage practices for reusable feeding tube stylets are varied and lack consensus guidelines. Almost 40% of critical care nurses do not cleanse reusable stylets. Our proof-of-concept study aimed to identify potential microbial contamination of stylets before and after cleansing with 70% isopropyl alcohol to establish practice standards. METHODS This prospective, exploratory pilot study sampled reusable feeding tube stylets using three different stylet sample sets. Set 1 included human participant stylets sampled for microbiome profile precleansing, and postcleansing and reinsertion into feeding tubes (n = 4). Sets 2 and 3 included stylets stored at the bedside. Set 2 included precleansed stylets for microbiome profiles (n = 5). Set 3 included precleansed and postcleansed stylets sampled for quantitative cultures (n = 5). Careful handling and storage protocols were used. Microbiome profiling used 16s ribosomal RNA gene amplicon sequencing. RESULTS Bacterial species identified on stylets were primarily common microflora and opportunistic pathogens, including Streptococcus pneumoniae, Staphylococcus aureus, Pseudomonas fulva, Cutibacterium acnes, Prevotella melaninogenica, and Lactobacillus paracasei. Microbiological culturing of stylet samples (set 3) did not yield growth for 9/10 samples; Staphylococcus capitis was identified in one postcleansed sample. Mean bacterial species diversity (alpha diversity) decreased following alcohol cleansing (M = 2.54 pre, M = 1.5 post; P = 0.006). CONCLUSION The abundance of several potentially opportunistic pathogens indicated plausible risk for gut contamination secondary to reinsertion of stylets into small-bore feeding tubes. Stylet cleansing with 70% isopropyl alcohol reduced bacterial burden on the stylets, although viability was unknown. Careful cleansing, handling, and storage protocols for reusable stylets are necessary to minimize contamination.
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Affiliation(s)
- Annette M Bourgault
- Academic Health Science Center, College of Nursing, University of Central Florida, Orlando, Florida, USA
| | - Chirajyoti Deb
- Translational Medicine Research, Translational Research and Specialty Diagnostic Laboratory, Orlando Health, Orlando, Florida
| | - Lillian Aguirre
- Trauma/Burn Critical Care, Orlando Regional Medical Center, a part of Orlando Health, Orlando, Florida
| | - Rui Xie
- Department of Statistics and Data Science, University of Central Florida, Orlando, Florida
| | - Kimberly Paige Rathbun
- Academic Health Science Center, College of Nursing, University of Central Florida, Orlando, Florida, USA
| | - Mary Lou Sole
- Academic Health Science Center, College of Nursing, University of Central Florida, Orlando, Florida, USA
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Liauchonak S, Hamilton S, Franks JD, Callif C, Akhondi-Asl A, Ariagno K, Mehta NM, Martinez EE. Impact of implementing an evidence-based definition of enteral nutrition intolerance on nutrition delivery: A prospective, cross-sectional cohort study. Nutr Clin Pract 2023; 38:376-385. [PMID: 36541429 PMCID: PMC10023272 DOI: 10.1002/ncp.10941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/28/2022] [Accepted: 11/05/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Enteral nutrition (EN) interruptions because of EN intolerance impede nutrient delivery. We aimed to examine whether revising the EN intolerance definition of an algorithm would decrease EN interruptions and improve nutrient delivery in critically ill children. METHODS We performed a cross-sectional cohort study including patients who were admitted to our intensive care unit (ICU) for >24 h and received EN. The EN intolerance definition in our nutrition algorithm was modified to include two symptoms of EN intolerance. We compared time to 60% EN adequacy (EN delivered/EN prescribed x 100) and EN interruptions before and after this intervention. RESULTS We included 150 eligible patients, 78 and 72 patients in the preimplementation and postimplementation cohorts, respectively. There were no significant differences in demographics and clinical characteristics. The preimplementation and postimplementation cohorts achieved 60% EN adequacy 4 (2-5) days and 3 (2-5) days after ICU admission, respectively (P = 0.59). The preimplementation cohort had a median of 1 (1-2) interruption per patient and the postimplementation cohort 2 (1-3; P = 0.08). The frequency of interruptions because of EN intolerance within the first 8 days of ICU admission was 17 in the preimplementation and 10 in the postimplementation cohorts. CONCLUSION Modifying the EN intolerance definition of a nutrition algorithm did not change the time to 60% EN adequacy or total number of EN interruptions in critically ill children. EN intolerance and interruptions continue to limit nutrient delivery. Research on the best definition for EN intolerance and its effect on nutrition outcomes is needed.
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Affiliation(s)
- Siarhei Liauchonak
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA
| | - Susan Hamilton
- Department of Surgery, Boston Children’s Hospital, Boston, MA
| | - Jennifer D. Franks
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA
| | - Charles Callif
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA
| | - Alireza Akhondi-Asl
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Katelyn Ariagno
- Center for Nutrition, Department of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, MA
| | - Nilesh M Mehta
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA
- Center for Nutrition, Department of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Enid E Martinez
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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El Khoury D, Pardo E, Cambriel A, Bonnet F, Pham T, Cholley B, Quesnel C, Verdonk F. Gastric Cross-Sectional Area to Predict Gastric Intolerance in Critically Ill Patients: The Sono-ICU Prospective Observational Bicenter Study. Crit Care Explor 2023; 5:e0882. [PMID: 36960310 PMCID: PMC10030198 DOI: 10.1097/cce.0000000000000882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Abstract
To evaluate the correlation between gastric cross-sectional area (GCSA) and the occurrence of gastric intolerance in critically ill patients within 24 hours of the measurement. DESIGN Two-center prospective observational study. SETTING Two academic ICUs in France between June 2020 and August 2021. PATIENTS All surgical intubated ICU patients greater than or equal to 18 years old receiving enteral feeding for greater than 12 hours. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Forty-four patients were included, 11 (25%) of whom presented digestive intolerance. Primary outcome was assessment of the association between GCSA and the occurrence of gastric intolerance within 24 hours of the measurement. GCSA value was significantly higher in patients with upper digestive intolerance compared to those without (553 mm2 [interquartile range (IQR), 500-649 mm2] vs 970 mm2 [IQR, 777-1,047]; p < 0.001, respectively). The optimal threshold for predicting upper digestive intolerance was 720 mm2 (area under the receiver operating characteristic curve 0.86; positive predictive value 62.5%; negative predictive value 96.4%; sensibility 0.91; and specificity 0.81). Multivariate analysis (weighted by propensity score), including known risk factors, showed that GCSA above the 720 mm2 threshold was independently associated with the occurrence of upper digestive intolerance (odds ratio, 1.85; 1.37-2.49; p < 0.0002). Measurement quality was "good" (i.e., liver, aorta, superior mesenteric vein, and pancreas were all visualized) in 81% of cases. CONCLUSIONS Measurement of GCSA by ultrasound would allow prediction of gastric intolerance in critically ill patients. This should be confirmed by a prospective score validation and interventional trials.
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Affiliation(s)
- Daniel El Khoury
- Department of Anaesthesiology and Intensive Care, Hôpital Saint-Antoine Assistance Publique des Hôpitaux de Paris and Sorbonne University, GRC 29, DMU DREAM, Paris, France
| | - Emmanuel Pardo
- Department of Anaesthesiology and Intensive Care, Hôpital Saint-Antoine Assistance Publique des Hôpitaux de Paris and Sorbonne University, GRC 29, DMU DREAM, Paris, France
| | - Amelie Cambriel
- Department of Anaesthesiology and Intensive Care, Hôpital Saint-Antoine Assistance Publique des Hôpitaux de Paris and Sorbonne University, GRC 29, DMU DREAM, Paris, France
| | - Francis Bonnet
- Department of Anaesthesiology and Intensive Care, Hôpital Saint-Antoine Assistance Publique des Hôpitaux de Paris and Sorbonne University, GRC 29, DMU DREAM, Paris, France
| | - Tai Pham
- Department of Intensive Care Medicine, Hôpital Kremlin Bicêtre Hospital and Paris Saclay University, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Bernard Cholley
- Department of Anaesthesiology and Critical Care Medicine, Hôpital Européen Georges Pompidou-Assistance Publique Hôpitaux de Paris, and Université Paris Cité, INSERM, Innovative Therapies in Haemostasis, Paris, France
| | - Christophe Quesnel
- Department of Anaesthesiology and Intensive Care, Hôpital Saint-Antoine Assistance Publique des Hôpitaux de Paris and Sorbonne University, GRC 29, DMU DREAM, Paris, France
| | - Franck Verdonk
- Department of Anaesthesiology and Intensive Care, Hôpital Saint-Antoine Assistance Publique des Hôpitaux de Paris and Sorbonne University, GRC 29, DMU DREAM, Paris, France
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Incidence and Risk Factors of Feeding Intolerance in Adult Patients Given Enteral Nutrition Therapy After Liver Transplant. TOP CLIN NUTR 2023. [DOI: 10.1097/tin.0000000000000305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Wang J, Chen Y, Xue H, Chen Z, Wang Q, Zhu M, Yao J, Yuan H, Zhang X. Effect of abdominal massage on feeding intolerance in patients receiving enteral nutrition: A systematic review and meta‐analysis. Nurs Open 2022; 10:2720-2733. [PMID: 36517968 PMCID: PMC10077396 DOI: 10.1002/nop2.1537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 10/26/2022] [Accepted: 11/20/2022] [Indexed: 12/23/2022] Open
Abstract
AIM This study aimed to evaluate the effect of abdominal massage (AM) on feeding intolerance (FI) in patients receiving enteral nutrition (EN). DESIGN A systematic review and meta-analysis. METHODS We searched seven electronic databases to September 2021. STATA and RevMan were used to analyse the data. RESULTS Eleven studies were included. The results revealed that AM could significantly reduce gastric residual volume and abdominal circumference difference, and reduce the incidence of gastric retention, vomiting, abdominal distention (all p < 0.001), diarrhoea (p = 0.02) and constipation (p = 0.002) in the experimental group. One study reported the incidence of aspiration in the control group was higher, but this was not statistically significant (p = 0.07). The meta-regression analysis showed there was a statistically significant correlation between intervention personnel and gastric residual volume (p = 0.035). CONCLUSION AM could reduce the amount and incidence of gastric retention and the changes in abdominal circumference, and significantly reduce the incidence of gastrointestinal symptoms, without increasing the incidence of aspiration for EN patients. No Patient or Public Contribution.
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Affiliation(s)
- Jia Wang
- Department of Fundamental Nursing, School of Nursing Jilin University Changchun China
- Shenzhen hospital of Southern Medical University Shenzhen China
| | - Yahong Chen
- Interventional operating room China‐Japan Union Hospital of Jilin University, Jilin University Changchun China
| | - Hui Xue
- Department of Histology and Embryology, College of Basic Medical Sciences Jilin University Changchun China
| | - Zhiming Chen
- Department of Fundamental Nursing, School of Nursing Jilin University Changchun China
| | - Qiuchen Wang
- Department of Fundamental Nursing, School of Nursing Jilin University Changchun China
| | - Mingyue Zhu
- Department of Fundamental Nursing, School of Nursing Jilin University Changchun China
| | - Jiannan Yao
- Department of Fundamental Nursing, School of Nursing Jilin University Changchun China
| | - Hua Yuan
- Department of Fundamental Nursing, School of Nursing Jilin University Changchun China
| | - Xiuying Zhang
- Department of Fundamental Nursing, School of Nursing Jilin University Changchun China
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Lakenman P, van Schie J, van der Hoven B, Baart S, Eveleens R, van Bommel J, Olieman J, Joosten K. Nutritional intake and gastro-intestinal symptoms in critically ill COVID-19 patients. Clin Nutr 2022; 41:2903-2909. [PMID: 35504769 PMCID: PMC8986274 DOI: 10.1016/j.clnu.2022.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND & AIMS Critically ill COVID-19 patients seem hypermetabolic and difficult to feed enterally, due to gastro-intestinal (GI) symptoms such as high gastric residual volumes (GRV) and diarrhea. Our aim was to describe the association of nutritional intake and GI symptoms during first 14 days of ICU admission. METHODS Observational study including critically ill adult COVID-19 patients. Data on nutritional intake [enteral nutrition (EN) or parenteral nutrition] and GI symptoms were collected during 14 days after ICU admission. Target energy and protein feeding goals were calculated conform ESPEN guidelines. GI symptoms included GRV (ml/d), vomiting, abdominal distension, and faeces (ml/d). High GRV's were classified as ≥2 times ≥150 ml/d and diarrhea as Bristol stool chart ≥6. GI symptoms were defined as mild if at least one symptom occurred and as moderate when ≥2 symptoms occurred. Acute gastrointestinal injury (AGI) grades of III were classified as GI dysfunction and grades of IV were considered as GI failure with severe impact on distant organs. Linear mixed model analysis was performed to explore the development of nutritional intake and GI symptoms over time at day (D) 0, 4, 10, and 14. RESULTS One hundred and fifty patients were included [75% male; median age 64 years (IQR 54-70)]. BMI upon admission was 28 kg/m2 (IQR 25-33), of which 43% obese (BMI > 30 kg/m2). Most patients received EN during admission (98% D4; 96% D10-14). Mean energy goals increased from 87% at D4 to 93% D10-14 and protein goals (g/kg) were increasingly achieved during admission (84% D4; 93% D10-14). Presence of moderate GI symptoms decreased (10% D0; 6% D4-10; 5% D14), reversely mild GI symptoms increased. Occurrence of GI dysfunction fluctuated (1% D0; 18% D4; 12% D10; 8% D14) and none of patients developed grade IV GI failure. Development of high GRV fluctuated (5% D0; 23% D4; 14% D10; 8% D14) and occurrence of diarrhea slightly increased during admission (5% D0; 22% D4; 25% D10; 27% D14). Linear mixed models showed only an association between AGI grades III and lower protein intake at day 10 (p = 0.020). CONCLUSION Occurrence of GI symptoms was limited and seems no major barrier for EN in our group of critically COVID-19 patients. Nutritional intake was just below requirements during the first 14 days of ICU admission. The effect on nutritional status remains to be studied.
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Affiliation(s)
- P.L.M. Lakenman
- Division of Dietetics, Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands,Corresponding author. Erasmus Medical Centre, Dr. M olewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - J.C. van Schie
- Division of Dietetics, Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - B. van der Hoven
- Department of Intensive Care Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - S.J. Baart
- Department of Biostatistics and Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - R.D. Eveleens
- Department of Anaesthesiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - J. van Bommel
- Department of Intensive Care Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - J.F. Olieman
- Division of Dietetics, Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - K.F.M. Joosten
- Intensive Care Unit, Department of Paediatrics and Paediatric Surgery, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, the Netherlands
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13
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Kothekar AT, Joshi AV. Gastric Ultrasound: POCUSing an Intolerant GUT! Indian J Crit Care Med 2022; 26:981-982. [PMID: 36213718 PMCID: PMC9492748 DOI: 10.5005/jp-journals-10071-24319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
How to cite this article: Kothekar AT, Joshi AV. Gastric Ultrasound: POCUSing an Intolerant GUT! Indian J Crit Care Med 2022;26(9):981–982.
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Affiliation(s)
- Amol Trimbakrao Kothekar
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
- Amol Trimbakrao Kothekar, Department of Anaesthesia, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India, e-mail:
| | - Anand Vinaykumar Joshi
- Department of Intensive Care Unit, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
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Prevalence and risk factors of enteral nutrition intolerance in intensive care unit patients: a retrospective study. Chin Med J (Engl) 2022; 135:1814-1820. [PMID: 35833658 PMCID: PMC9521784 DOI: 10.1097/cm9.0000000000001974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Feeding intolerance (FI) among intensive care unit (ICU) patients undergoing early continuous enteral nutrition (EN) is related to poor outcomes. This study aimed to explore the prevalence and risk factors of FI in ICU patients. METHODS We retrospectively enrolled 1057 patients who received early continuous EN via a nasogastric tube between January 2014 and August 2019. The prevalence of FI during the first 7 days of ICU stay was calculated, and the risk factors were investigated using multivariate logistic regression analysis. RESULTS The prevalence of FI during the first 7 days of ICU stay was 10.95%. FI occurred in 159 of 1057 (15.04%) patients on ICU day 2, 114 of 977 (11.67%) patients on ICU day 3, and 86 of 715 (12.03%) patients on ICU day 7. Mechanical ventilation (MV) (odds ratio [OR]: 1.928, 95% confidence interval [CI]: 1.064-3.493, P = 0.03) was an independent risk factor for FI defined by a gastric residual volume (GRV) of 200 mL and/or vomiting, and acute renal failure (OR: 3.445, 95% CI: 1.115-10.707, P = 0.032) was an independent risk factor of FI defined by a GRV of 500 mL and/or vomiting. Continuous renal replacement therapy (CRRT) was an independent predictor regardless of the FI defined by a GRV of 200 mL (OR: 2.064, 95% CI: 1.233-3.456, P = 0.006) or 500 mL (OR: 6.199, 95% CI: 2.108-18.228, P = 0.001) in the ICU patients. CONCLUSIONS FI occurs frequently in early ICU days, especially in patients receiving MV and CRRT. However, further investigation of a consensus definition of FI and risk factors is still warranted in future studies.
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Seismic Resilience Assessment in Optimally Integrated Retrofitting of Existing School Buildings in Italy. BUILDINGS 2022. [DOI: 10.3390/buildings12060845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Modern society requires that structures exhibit greater levels of resilience, especially under earthquakes. The seismic resilience of buildings is thus gaining increased attention as a particular, beyond-code approach. Seismically retrofitted buildings behave satisfactorily under expected earthquake scenarios; however, this does not guarantee operativity after a seismic event. This study critically reviews several methods currently available in the literature that quantify the seismic resilience level of buildings from different perspectives. An existing reinforced concrete school building, retrofitted according to four distinct strategies, is first evaluated in terms of seismic resilience levels. The overview and critical analysis of available resilience assessment frameworks determine the most suitable parameters to measure the seismic resilience for buildings. Subsequently, this metric is incorporated as an additional decision variable into an integrated seismic and energy retrofitting set of strategies. A multicriteria decision-making analysis is performed to select the optimally combined seismic and energy retrofitting alternative under social, technical, environmental evaluation, and seismic resilience aspects. We show how resilience impacts the preference for integrated seismic and energy retrofitting strategies, especially when this metric is considered as an annualized expected value.
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Added Value of CCTA-Derived Features to Predict MACEs in Stable Patients Undergoing Coronary Computed Tomography. Diagnostics (Basel) 2022; 12:diagnostics12061446. [PMID: 35741256 PMCID: PMC9222004 DOI: 10.3390/diagnostics12061446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/05/2022] [Accepted: 06/09/2022] [Indexed: 11/17/2022] Open
Abstract
Clinical evidence has emphasized the importance of coronary plaques’ characteristics, rather than lumen stenosis, for the outcome of cardiovascular events. Coronary computed tomographic angiography (CCTA) has a well-established role as a non-invasive tool for assessing plaques. The aim of this study was to compare clinical characteristics and CCTA-derived information of stable patients with non-severe plaques in predicting major adverse cardiac events (MACEs) during follow-up. We retrospectively selected 371 patients (64% male) who underwent CCTA in our center from March 2016 to January 2021 with Coronary Artery Disease—Reporting and Data System (CAD-RADS) 0 to 3. Of those, 198 patients (53% male) had CAD-RADS 0 to 1. Among them, 183 (49%) had normal pericoronary fat attenuation index (pFAI), while 15 (60% male) had pFAI ≥ 70.1 Hounsfield unit (HU). The remaining 173 patients (76% male) had CAD-RADS 2 to 3 and were divided into patients with at least one low attenuation plaque (LAP) and patients without LAPs (n-LAP). Compared to n-LAP, patients with LAPs had higher pFAI (p = 0.005) and had more plaques than patients with n-LAP. Presence of LAPs was significantly higher in elderly (p < 0.001), males (p < 0.001) and patients with traditional risk factors (hypertension p = 0.0001, hyperlipemia p = 0.0003, smoking p = 0.0003, diabetes p = <0.0001, familiarity p = 0.0007). Among patients with CAD-RADS 0 to 1, the ones with pFAI ≥ 70.1 HU were more often hyperlipidemic (p = 0.05) and smokers (p = 0.007). Follow-up (25,4 months, range: 17.6−39.2 months) demonstrated that LAP and pFAI ≥ 70.1 significantly and independently (p = 0.04) predisposed to outcomes (overall mortality and interventional procedures). There is an added value of CCTA-derived features in stratifying cardiovascular risk in low- to intermediate-risk patients with non-severe, non-calcified coronary plaques. This is of utmost clinical relevance as it is possible to identify a subset of patients with increased risk who need strengthening in therapeutic management and closer follow-up even in the absence of severe CAD. Further studies are needed to evaluate the effect of medical treatments on pericoronary inflammation and plaque composition.
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18
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Virtual Power Plants Optimization Issue: A Comprehensive Review on Methods, Solutions, and Prospects. ENERGIES 2022. [DOI: 10.3390/en15103607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Recently, the integration of distributed generation and energy systems has been associated with new approaches to plant operations. As a result, it is becoming increasingly important to improve management skills related to distributed generation and demand aggregation through different types of virtual power plants (VPPs). It is also important to leverage their ability to participate in electricity markets to maximize operating profits. The present study focuses on VPP concepts, its different potential services, various control methodologies, distinct optimization approaches, and some practical implemented real cases. To this end, a comprehensive review of the most recent scientific literature is conducted. The paper concludes with remained challenges and future trends in the topic.
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Nan M, Xue H, Bi Y. Contamination, Detection and Control of Mycotoxins in Fruits and Vegetables. Toxins (Basel) 2022; 14:toxins14050309. [PMID: 35622556 PMCID: PMC9143439 DOI: 10.3390/toxins14050309] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/18/2022] [Accepted: 04/24/2022] [Indexed: 01/09/2023] Open
Abstract
Mycotoxins are secondary metabolites produced by pathogenic fungi that colonize fruits and vegetables either during harvesting or during storage. Mycotoxin contamination in fruits and vegetables has been a major problem worldwide, which poses a serious threat to human and animal health through the food chain. This review systematically describes the major mycotoxigenic fungi and the produced mycotoxins in fruits and vegetables, analyzes recent mycotoxin detection technologies including chromatography coupled with detector (i.e., mass, ultraviolet, fluorescence, etc.) technology, electrochemical biosensors technology and immunological techniques, as well as summarizes the degradation and detoxification technologies of mycotoxins in fruits and vegetables, including physical, chemical and biological methods. The future prospect is also proposed to provide an overview and suggestions for future mycotoxin research directions.
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Affiliation(s)
- Mina Nan
- College of Science, Gansu Agricultural University, Lanzhou 730070, China;
- Basic Experiment Teaching Center, Gansu Agricultural University, Lanzhou 730070, China
| | - Huali Xue
- College of Science, Gansu Agricultural University, Lanzhou 730070, China;
- Correspondence: (H.X.); (Y.B.); Tel.: +86-931-763-1212 (H.X.); +86-931-763-1113 (Y.B.)
| | - Yang Bi
- College of Food Science and Engineering, Gansu Agricultural University, Lanzhou 730070, China
- Correspondence: (H.X.); (Y.B.); Tel.: +86-931-763-1212 (H.X.); +86-931-763-1113 (Y.B.)
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20
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He FJ, Wang MJ, Yang K, Chen XL, Jin T, Zhu LL, Zhuang W. Effects of Preoperative Oral Nutritional Supplements on Improving Postoperative Early Enteral Feeding Intolerance and Short-Term Prognosis for Gastric Cancer: A Prospective, Single-Center, Single-Blind, Randomized Controlled Trial. Nutrients 2022; 14:nu14071472. [PMID: 35406085 PMCID: PMC9002901 DOI: 10.3390/nu14071472] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Early enteral nutrition (EN) after abdominal surgery can improve the prognosis of patients. However, the high feeding intolerance (FI) rate is the primary factor impeding postoperative EN. METHODS Sixty-seven patients who underwent radical subtotal or total gastrectomy for gastric cancer (GC) were randomly allocated to the preoperative oral nutritional supplement group (ONS group) or dietary advice alone (DA group). Both groups were fed via nasojejunal tubes (NJs) from the first day after surgery to the fifth day. The primary endpoint is the FI rate. RESULTS Of the patients, 66 completed the trial (31 in the ONS group, 35 in the DA group). The FI rate in the ONS group was lower than that in the DA group (25.8% vs. 31.4%, p = 0.249). The postoperative five-day 50% energy compliance rate in the ONS group was higher than that in the DA group (54.8% vs. 48.6%, p = 0.465). The main gastrointestinal intolerance symptoms were distension (ONS vs. DA: 45.2% vs. 62.9, p = 0.150) and abdominal pain (ONS vs. DA: 29.0% vs. 45.7%, p = 0.226). Postoperative nausea/vomiting rate and heartburn/reflux rate were similar between the two groups. We noted no difference in perioperative serum indices, short-term prognosis or postoperative complication rates between the two groups. CONCLUSIONS The study shows that short-term preoperative ONS cannot significantly improve FI and the energy compliance rate in the early stage after radical gastrectomy.
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Affiliation(s)
- Feng-Jun He
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu 610044, China; (F.-J.H.); (T.J.); (L.-L.Z.)
| | - Mo-Jin Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610044, China; (M.-J.W.); (K.Y.); (X.-L.C.)
| | - Kun Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610044, China; (M.-J.W.); (K.Y.); (X.-L.C.)
| | - Xiao-Long Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610044, China; (M.-J.W.); (K.Y.); (X.-L.C.)
| | - Tao Jin
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu 610044, China; (F.-J.H.); (T.J.); (L.-L.Z.)
| | - Li-Li Zhu
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu 610044, China; (F.-J.H.); (T.J.); (L.-L.Z.)
| | - Wen Zhuang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610044, China; (M.-J.W.); (K.Y.); (X.-L.C.)
- Correspondence: ; Tel.: +86-189-8060-1497; Fax: +86-28-8542-2708
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21
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A systematic review of the definitions and prevalence of feeding intolerance in critically ill adults. Clin Nutr ESPEN 2022; 49:92-102. [DOI: 10.1016/j.clnesp.2022.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/08/2022] [Accepted: 04/15/2022] [Indexed: 12/12/2022]
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22
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Enteral nutrition interruptions in the intensive care unit: A prospective study. Nutrition 2022; 96:111580. [DOI: 10.1016/j.nut.2021.111580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 12/04/2021] [Accepted: 12/18/2021] [Indexed: 01/03/2023]
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23
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Ke L, Lin J, Doig GS, van Zanten ARH, Wang Y, Xing J, Zhang Z, Chen T, Zhou L, Jiang D, Shi Q, Lin J, Liu J, Cheng A, Liang Y, Gao P, Sun J, Liu W, Yang Z, Zhang R, Xing W, Zhang A, Zhou Z, Zhou T, Liu Y, Tong F, Wang Q, Pan A, Huang X, Fan C, Lu W, Shi D, Wang L, Li W, Gu L, Xie Y, Sun R, Guo F, Han L, Zhou L, Zheng X, Shan F, Liu J, Ai Y, Qu Y, Li L, Li H, Pan Z, Xu D, Zou Z, Gao Y, Yang C, Kou Q, Zhang X, Wu J, Qian C, Zhang W, Zhang M, Zong Y, Qin B, Zhang F, Zhai Z, Sun Y, Chang P, Yu B, Yu M, Yuan S, Deng Y, Zhao L, Zang B, Li Y, Zhou F, Chen X, Shao M, Wu W, Wu M, Zhang Z, Li Y, Guo Q, Wang Z, Gong Y, Song Y, Qian K, Feng Y, Fu B, Liu X, Li Z, Gong C, Sun C, Yu J, Tang Z, Huang L, Ma B, He Z, Zhou Q, Yu R, Tong Z, Li W. Actively implementing an evidence-based feeding guideline for critically ill patients (NEED): a multicenter, cluster-randomized, controlled trial. Crit Care 2022; 26:46. [PMID: 35172856 PMCID: PMC8848648 DOI: 10.1186/s13054-022-03921-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/31/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Previous cluster-randomized controlled trials evaluating the impact of implementing evidence-based guidelines for nutrition therapy in critical illness do not consistently demonstrate patient benefits. A large-scale, sufficiently powered study is therefore warranted to ascertain the effects of guideline implementation on patient-centered outcomes. METHODS We conducted a multicenter, cluster-randomized, parallel-controlled trial in intensive care units (ICUs) across China. We developed an evidence-based feeding guideline. ICUs randomly allocated to the guideline group formed a local "intervention team", which actively implemented the guideline using standardized educational materials, a graphical feeding protocol, and live online education outreach meetings conducted by members of the study management committee. ICUs assigned to the control group remained unaware of the guideline content. All ICUs enrolled patients who were expected to stay in the ICU longer than seven days. The primary outcome was all-cause mortality within 28 days of enrollment. RESULTS Forty-eight ICUs were randomized to the guideline group and 49 to the control group. From March 2018 to July 2019, the guideline ICUs enrolled 1399 patients, and the control ICUs enrolled 1373 patients. Implementation of the guideline resulted in significantly earlier EN initiation (1.20 vs. 1.55 mean days to initiation of EN; difference - 0.40 [95% CI - 0.71 to - 0.09]; P = 0.01) and delayed PN initiation (1.29 vs. 0.80 mean days to start of PN; difference 1.06 [95% CI 0.44 to 1.67]; P = 0.001). There was no significant difference in 28-day mortality (14.2% vs. 15.2%; difference - 1.6% [95% CI - 4.3% to 1.2%]; P = 0.42) between groups. CONCLUSIONS In this large-scale, multicenter trial, active implementation of an evidence-based feeding guideline reduced the time to commencement of EN and overall PN use but did not translate to a reduction in mortality from critical illness. TRIAL REGISTRATION ISRCTN, ISRCTN12233792 . Registered November 20th, 2017.
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Affiliation(s)
- Lu Ke
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210000, Jiangsu Province, China
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, China
| | - Jiajia Lin
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210000, Jiangsu Province, China
| | - Gordon S Doig
- Northern Clinical School, Royal North Shore Hospital, University of Sydney, Sydney, Australia
| | - Arthur R H van Zanten
- Department of Intensive Care Medicine, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands
| | - Yang Wang
- Department of Medical Research and Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | - Zhongheng Zhang
- Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tao Chen
- Tropical Clinical Trials Unit, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Lixin Zhou
- First People's Hospital of Foshan, Foshan, China
| | - Dongpo Jiang
- Daping Hospital, Army Medical University, Chongqing, China
| | - Qindong Shi
- First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Jiandong Lin
- First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jun Liu
- Suzhou Municipal Hospital, Suzhou, China
| | - Aibin Cheng
- North China University of Science and Technology Affiliated Hospital, Tangshan, China
| | - Yafeng Liang
- Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
| | - Peiyang Gao
- Chengdu University of Traditional Chinese Medicine Affiliated Hospital, Chengdu, China
| | - Junli Sun
- Luoyang Central Hospital Affiliated To Zhengzhou University, Luoyang, China
| | - Wenming Liu
- Changzhou No. 2 People's Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Zhenyu Yang
- The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | | | - Wei Xing
- Department of Intensive Care Medicine, The Third Xiangya Hospital of Central South University, Changsha, China
| | - An Zhang
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhigang Zhou
- First People's Hospital of Kunming, Kunming, China
| | | | - Yang Liu
- Tangshan Gongren Hospital, Tangshan, China
| | - Fei Tong
- Hebei Medical University Second Affiliated Hospital, Shijiazhuang, China
| | | | - Aijun Pan
- Anhui Provincial Hospital, Hefei, China
| | - Xiaobo Huang
- Department of Critical Care Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Chuming Fan
- First People's Hospital of Yunnan, Kunming, China
| | - Weihua Lu
- Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Dongwu Shi
- Shanxi Provincial People's Hospital, Taiyuan, China
| | - Lei Wang
- Shanxi Medical University First Affiliated Hospital, Taiyuan, China
| | - Wei Li
- The People's Hospital of Fujian Province, Fuzhou, China
| | - Liming Gu
- People's Hospital of Yuxi City, Yuxi, China
| | | | - Rongqing Sun
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Feng Guo
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lin Han
- People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Lihua Zhou
- Affiliated Hospital of Inner Mongolia Medical College, Huhehaote, China
| | | | - Feng Shan
- Qindao University Medical College Affiliated Hospital, Qindao, China
| | - Jianbo Liu
- Inner Mongolia People's Hospital, Huhehaote, China
| | - Yuhang Ai
- Xiangya Hospital Central South University, Changsha, China
| | - Yan Qu
- Qingdao Municipal Hospital Group, Qingdao, China
| | - Liandi Li
- Qindao University Medical College Affiliated Hospital, Qindao, China
| | - Hailing Li
- No.971 Hospital of People's Liberation Army Navy, Qingdao, China
| | - Zhiguo Pan
- General Hospital of Southern Theatre Command, Guangzhou, China
| | - Donglin Xu
- Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Zhiqiang Zou
- Union Hospital of Fujian Medical University, Fuzhou, China
| | - Yan Gao
- The General Hospital of Shenyang Military, Shenyan, China
| | - Chunli Yang
- Jiangxi Provincial People's Hospital, Nanchang, China
| | - Qiuye Kou
- The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xijing Zhang
- Department of Anaesthesiology and Perioperative Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Jinglan Wu
- Shenzhen Nanshan People's Hospital, Shenzhen, China
| | - Chuanyun Qian
- Kuming Medical University First Affiliated Hospital, Kuming, China
| | - Weixing Zhang
- Peking University Shenzhen Hospital, Guandong, China
| | - Minjie Zhang
- General ICU, Jinan University First Affiliated Hospital, Jinan, China
| | - Yuan Zong
- Shaanxi Provincial People's Hospital, Xi'an, China
| | - Bingyu Qin
- Henan Provincial People's Hospital, Zhengzhou, China
| | | | - Zhe Zhai
- The Fourth Hospital of Harbin Medical University, Harbin, China
| | - Yun Sun
- Anhui Medical University Second Affiliated Hospital, Hefei, China
| | - Ping Chang
- Southern Medical University Zhujiang Hospital, Guangzhou, China
| | - Bo Yu
- Department of Critical Care Medicine, the Second Xiangya Hospital of Central South University, Changsha, 410000, Hunan, China
| | - Min Yu
- First People's Hospital of Yichang, Yichang, China
| | - Shiying Yuan
- Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Yijun Deng
- Yancheng First People's Hospital, Yancheng, China
| | - Liyun Zhao
- Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, China
| | - Bin Zang
- China Medical University Affiliated Shengjing Hospital, Shenyang, China
| | - Yuanfei Li
- Changsha Central Hospital Affiliated to University of South China, Changsha, China
| | - Fachun Zhou
- Chongqing Medical University First Affiliated Hospital, Chongqing, China
| | - Xiaomei Chen
- Department of Critical Care Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Min Shao
- The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | | | - Ming Wu
- Health Science Center, The Second People's Hospital of Shenzhen, First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | | | - Yimin Li
- First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qiang Guo
- First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhiyong Wang
- Hebei Medical University, Third Affiliated Hospital, Shijiazhuang, China
| | - Yuanqi Gong
- The Second Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Yunlin Song
- The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Kejian Qian
- The First Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Yongjian Feng
- Neurosurgical ICU, Jinan University First Affiliated Hospital, Jinan, China
| | - Baocai Fu
- Yantai Mountain Hospital, Yantai, China
| | - Xueyan Liu
- Shenzhen People's Hospital, Shenzhen, China
| | - Zhiping Li
- Hunan Provincial People's Hospital, Changsha, China
| | - Chuanyong Gong
- Tianjing Hospital of Integration of Chinese and Western Medicine, Tianjing, China
| | - Cheng Sun
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jian Yu
- The Second Hospital of Dalian Medical University, Liaoning, China
| | - Zhongzhi Tang
- Wuhan General Hospital of Guangzhou Military Region, Wuhan, China
| | - Linxi Huang
- Shantou University Medical College First Affiliated Hospital, Shantou, China
| | - Biao Ma
- Jining Medical College Affiliated Hospital, Jining, China
| | - Zhijie He
- Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | | | - Rongguo Yu
- Fujian Provincial Hospital, Fujian, China
| | - Zhihui Tong
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210000, Jiangsu Province, China.
| | - Weiqin Li
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210000, Jiangsu Province, China.
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, China.
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Affiliation(s)
- Yaseen M. Arabi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia,Address for correspondence: Dr. Yaseen M. Arabi, Intensive Care Department, King Abdulaziz Medical City, ICU2, Mail Code 1425, PO Box 22490, Riyadh - 11426, Saudi Arabia. E-mail:
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25
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Drakos P, Volteas P, Cleri NA, Alkadaa LN, Asencio AA, Oganov A, Pryor A, Talamini M, Rubano J, Bannazadeh M, Mikell CB, Spaniolas K, Mofakham S. Acute Gastrointestinal Injury and Feeding Intolerance as Prognostic Factors in Critically Ill COVID-19 Patients. J Gastrointest Surg 2022; 26:181-190. [PMID: 33905039 PMCID: PMC8077860 DOI: 10.1007/s11605-021-05015-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/12/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although acute gastrointestinal injury (AGI) and feeding intolerance (FI) are known independent determinants of worse outcomes and high mortality in intensive care unit (ICU) patients, the incidence of AGI and FI in critically ill COVID-19 patients and their prognostic importance have not been thoroughly studied. METHODS We reviewed 218 intubated patients at Stony Brook University Hospital and stratified them into three groups based on AGI severity, according to data collected in the first 10 days of ICU course. We used chi-square test to compare categorical variables such as age and sex and two-sample t-test or Mann-Whitney U-tests for continuous variables, including important laboratory values. Cox proportional hazards regression models were utilized to determine whether AGI score was an independent predictor of survival, and multivariable analysis was performed to compare risk factors that were deemed significant in the univariable analysis. We performed Kaplan-Meier survival analysis based on the AGI score and the presence of FI. RESULTS The overall incidence of AGI was 95% (45% AGI I/II, 50% AGI III/IV), and FI incidence was 63%. Patients with AGI III/IV were more likely to have prolonged mechanical ventilation (22 days vs 16 days, P-value <0.002) and higher mortality rate (58% vs 28%, P-value <0.001) compared to patients with AGI 0/I/II. This was confirmed with multivariable analysis which showed that AGI score III/IV was an independent predictor of higher mortality (AGI III/IV vs AGI 0/I/II hazard ratio (HR), 2.68; 95% confidence interval (CI), 1.69-4.25; P-value <0.0001). Kaplan-Meier survival analysis showed that both AGI III/IV and FI (P-value <0.001) were associated with worse outcomes. Patients with AGI III/IV had higher daily and mean D-dimer and CRP levels compared to AGI 0/I/II (P-value <0.0001). CONCLUSIONS The prevalence of AGI and FI among critically ill COVID-19 patients was high. AGI grades III/IV were associated with higher risk for prolonged mechanical ventilation and mortality compared to AGI 0/I/II, while it also correlated with higher D-dimer and C-reactive protein (CRP) levels. FI was independently associated with higher mortality. The development of high-grade AGI and FI during the first days of ICU stay can serve as prognostic tools to predict outcomes in critically ill COVID-19 patients.
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Affiliation(s)
- Panagiotis Drakos
- Department of Surgery, Renaissance School of Medicine, HSC T-12, Room 064, Stony Brook, NY, 11794, USA
| | - Panagiotis Volteas
- Department of Surgery, Renaissance School of Medicine, HSC T-12, Room 064, Stony Brook, NY, 11794, USA
| | - Nathaniel A Cleri
- Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Leor N Alkadaa
- Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Anthony A Asencio
- Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Anthony Oganov
- Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Aurora Pryor
- Department of Surgery, Renaissance School of Medicine, HSC T-12, Room 064, Stony Brook, NY, 11794, USA
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Mark Talamini
- Department of Surgery, Renaissance School of Medicine, HSC T-12, Room 064, Stony Brook, NY, 11794, USA
| | - Jerry Rubano
- Department of Surgery, Renaissance School of Medicine, HSC T-12, Room 064, Stony Brook, NY, 11794, USA
| | - Mohsen Bannazadeh
- Department of Surgery, Renaissance School of Medicine, HSC T-12, Room 064, Stony Brook, NY, 11794, USA
- Division of Vascular Surgery, Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Charles B Mikell
- Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Konstantinos Spaniolas
- Department of Surgery, Renaissance School of Medicine, HSC T-12, Room 064, Stony Brook, NY, 11794, USA.
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA.
| | - Sima Mofakham
- Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, USA.
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26
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Vijayaraghavan R, Maiwall R, Arora V, Choudhary A, Benjamin J, Aggarwal P, Jamwal KD, Kumar G, Joshi YK, Sarin SK. Reversal of Feed Intolerance by Prokinetics Improves Survival in Critically Ill Cirrhosis Patients. Dig Dis Sci 2022; 67:4223-4233. [PMID: 34392492 PMCID: PMC8364303 DOI: 10.1007/s10620-021-07185-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/19/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS Feed intolerance (FI) is common in cirrhosis patients in intensive care units (ICU). Prokinetics are the first line treatment for FI but their efficacy and safety in critically ill patient with cirrhosis is unknown. We evaluated the role of prokinetics in reversal of FI and clinical outcomes. METHODS Consecutive patients admitted in ICU developing new-onset FI, were randomized to receive either intravenous metoclopramide (Gr.A, n = 28), erythromycin (Gr.B, n = 27) or placebo (Gr.C, n = 28). FI was defined with the presence of 3 of 5 variables- absence of bowel sounds, gastric residual volume ≥ 500 ml, vomiting, diarrhoea and bowel distension. Primary end-point was complete resolution of FI (≥ 3 variables resolved) within 24-h and secondary end-points included resolution within 72-h and survival at 7-days. RESULTS Of the 1030 ICU patients, 201 (19.5%) developed FI and 83 patients were randomized. Baseline parameters between the groups were comparable. Complete resolution at 24-h was higher in Gr.A (7.14%) and B (22.2%) than C (0%, p = 0.017). Overall, 58 (69.9%) patients achieved resolution within 72 h, more with metoclopramide (n = 24, 85.7%) and erythromycin (n = 25, 92.6%) than with placebo (n = 9, 32.1%, p < 0.001). The 7-day survival was better in patients who achieved resolution within 72-h (65.5 vs. 36%, p = 0.011) than non-responders. High lactate (OR-3.32, CI-1.45-7.70, p = 0.005), shock at baseline (OR-6.34, CI-1.67-24.1, p = 0.007) and resolution of FI within 72 h (OR-0.11, CI, 0.03-0.51, p = 0.04) predicted 7-day mortality. CONCLUSIONS FI is common in critically-ill cirrhosis patients and non-resolution carries high mortality. Early recognition and treatment with prokinetics is recommended to improve short-term survival.
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Affiliation(s)
- Rajan Vijayaraghavan
- grid.418784.60000 0004 1804 4108Department of Hepatology, Institute of Liver and Biliary Sciences, D-1 Vasant Kunj, New Delhi, 110070 India
| | - Rakhi Maiwall
- grid.418784.60000 0004 1804 4108Department of Hepatology, Institute of Liver and Biliary Sciences, D-1 Vasant Kunj, New Delhi, 110070 India
| | - Vinod Arora
- grid.418784.60000 0004 1804 4108Department of Hepatology, Institute of Liver and Biliary Sciences, D-1 Vasant Kunj, New Delhi, 110070 India
| | - Ashok Choudhary
- grid.418784.60000 0004 1804 4108Department of Hepatology, Institute of Liver and Biliary Sciences, D-1 Vasant Kunj, New Delhi, 110070 India
| | - Jaya Benjamin
- grid.418784.60000 0004 1804 4108Department of Clinical Nutrition, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Prashant Aggarwal
- grid.418784.60000 0004 1804 4108Department of Anaesthesia and Critical Care, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Kapil Dev Jamwal
- grid.464746.30000 0004 1761 4703Department of Gastroenterology, Artemis Hospitals, Gurugram, Haryana India
| | - Guresh Kumar
- grid.418784.60000 0004 1804 4108Department of Clinical Research, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Y. K. Joshi
- grid.418784.60000 0004 1804 4108Department of Clinical Nutrition, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Shiv K. Sarin
- grid.418784.60000 0004 1804 4108Department of Hepatology, Institute of Liver and Biliary Sciences, D-1 Vasant Kunj, New Delhi, 110070 India
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Yahyapoor F, Dehnavi Z, Askari G, Ranjbar G, Hejri Zarifi S, Bagherniya M, Rezaian MK, Moghadaam AB, Fazeli F, Sedaghat A. The prevalence and possible causes of enteral tube feeding intolerance in critically ill patients: A cross-sectional study. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2021; 26:60. [PMID: 34729068 PMCID: PMC8506243 DOI: 10.4103/jrms.jrms_689_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/08/2020] [Accepted: 04/07/2021] [Indexed: 01/03/2023]
Abstract
Background: Enteral tube feeding intolerance (ETFI) is one of the most common complications of enteral nutrition (EN), which may lead to increased mortality and length of intensive care unit (ICU) stay. This study aimed to determine the prevalence of ETFI and effects on feeding intolerance on nutrition and clinical outcomes in Iran. Materials and Methods: This cross-sectional study was conducted in 2019 at the three general ICUs of Imam Reza Hospital in Mashhad, Iran, during 7 days on 245 patients. The collected data included demographic characteristics, primary diagnosis, the Acute Physiology and Chronic Health Evaluation II (APACHE ІІ) score, Sequential Organ Failure Assessment (SOFA) score, duration of mechanical ventilation, and length of ICU stay. Feeding intolerance was assessed using daily questionnaires for 7 days. ETFI was determined as the interruption of EN based on gastrointestinal causes, including large gastric residuals, abdominal distension, vomiting, diarrhea, and subjective discomfort. Results: Overall, 245 critically ill patients (122 males and 123 females) were included in this study, with a mean age of 58.43 ± 19.2 years in three general ICUs. The highest prevalence rate of ETFI was 91.8%, which occurred on the 2nd day although the rate decreased in the following days. The minimum ETFI was observed on the last day (38.8%). Feeding intolerance was associated with the increased APACHE II scores (P = 0.04), SOFA scores (P < 0.001), and duration of mechanical ventilation (P < 0.001) compared with the tolerant patients. The most common causes of ETFI in the patients admitted to the ICU were gastric residual volume (GRV), large GRV, vomiting, and distension. Conclusion: ETFI was prevalent in almost two-third (66%) of the critically ill patients receiving EN based on the GRV. ETFI was associated with deteriorated nutritional status and clinical outcomes.
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Affiliation(s)
- Farveh Yahyapoor
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Dehnavi
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gholamreza Askari
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Golnaz Ranjbar
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sudiyeh Hejri Zarifi
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Bagherniya
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Khadem Rezaian
- Clinical Research Development Unit, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ahmad Bagheri Moghadaam
- Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farzane Fazeli
- Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Sedaghat
- Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Lin J, Liu Y, Ke L, Li G, Lv C, Zhou J, Ye B, Li B, Yang Q, Tong Z, Li W, Li J, For The Chinese Critical Care Nutrition Trials Group Cccntg. Feeding intolerance score in critically ill patients with enteral nutrition: A post hoc analysis of a prospective study. Nutr Clin Pract 2021; 37:869-877. [PMID: 34679200 DOI: 10.1002/ncp.10788] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Feeding intolerance (FI) is common in critically ill patients fed with enteral nutrition. Although there is increasing evidence showing the association between FI and mortality, no reliable quantitative assessment was available in clinical practice. In this study, we proposed a FI scoring system based on gastrointestinal (GI) symptoms to assist the implementation of enteral nutrition and assessed its association with 28-day mortality. METHODS This is a post hoc analysis based on data collected in a previous cross-sectional study. All adult patients who were enterally fed were included. Various definitions of FI were compared. The area under the receiver operating characteristic (AUROC) was used to assess the predictive performance for 28-day mortality. Pearson correlation coefficient and the variance inflation factor were applied to detect collinearity among variables. Multiple logistic regression analysis was used to determine the risk factors for 28-day mortality. RESULTS Of the 1098 patients included, 200 (18.2%) were nonsurvivors. The incidence of GI symptoms was higher in nonsurvivors on the study day. The multiple logistic regression analysis showed that the proposed FI score was an independent risk factor for 28-day mortality (odds ratio [OR]: 1.37; 95% CI, 1.25-1.51; P < .001). Moreover, the FI score showed better predictive accuracy for 28-day mortality than the other definitions (AUROC: 0.633 [95% CI, 0.591-0.675] for the FI score vs 0.595 (95% CI, 0.557-0.633] for the best-performing FI definition [P = 0.001]). CONCLUSIONS FI score is independently associated with 28-day mortality in critically ill patients with acceptable predictive accuracy.
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Affiliation(s)
- Jiajia Lin
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, PR China
| | - Yang Liu
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, PR China
| | - Lu Ke
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, PR China.,National Institute of Healthcare Data Science, Nanjing University, Nanjing, China
| | - Gang Li
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, PR China
| | - Cheng Lv
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, PR China
| | - Jing Zhou
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, PR China
| | - Bo Ye
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, PR China
| | - Baiqiang Li
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, PR China
| | - Qi Yang
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, PR China
| | - Zhihui Tong
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, PR China
| | - Weiqin Li
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, PR China.,National Institute of Healthcare Data Science, Nanjing University, Nanjing, China
| | - Jieshou Li
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, PR China
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Padar M, Starkopf J, Starkopf L, Forbes A, Hiesmayr M, Jakob SM, Rooijackers O, Wernerman J, Ojavee SE, Reintam Blaser A. Enteral nutrition and dynamics of citrulline and intestinal fatty acid-binding protein in adult ICU patients. Clin Nutr ESPEN 2021; 45:322-332. [PMID: 34620335 DOI: 10.1016/j.clnesp.2021.07.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIMS Plasma citrulline and intestinal fatty acid binding protein (I-FABP) are biomarkers reflecting enterocyte function and intestinal mucosal injury. The aim was to describe daily dynamics of citrulline and I-FABP concentrations in association with enteral nutrition (EN) in adult ICU patients. We hypothesized that success or failure of EN is reflected by differences in citrulline and I-FABP levels at admission, as well as in daily dynamics over the first week. METHODS The present study was a planned sub-study of the iSOFA study (ClinicalTrials.gov Identifier: NCT02613000). With delayed informed consent we included adult (18 years or older) patients admitted for unlimited care to 5 ICUs in Europe. Citrulline and I-FABP were assessed and nutritional data recorded daily during the first week of the patients' ICU stay. RESULTS The study included 224 patients with 693 plasma samples analyzed for citrulline and 695 for I-FABP. The median ICU stay was 2 (IQR 1-4) days and 35 patients (15.6 %) stayed in the ICU for ≥ 7 days. The majority of patients (184/224; 82.1 %) received EN or oral nutrition (ON) during their ICU stay, in 164 patients (73.2 %) nutrition was started within 48 h of admission (early enteral or oral nutrition, EEN/ON). Median biomarker concentrations on admission were: citrulline 24.5 (IQR 18.1-31.7) μmol/L and I-FABP 2763 (1326-4805) pg/mL. Reference range for citrulline was 17-46 μmol/L and for I-FABP 377-2049 pg/mL. Patients with EEN/ON demonstrated an increase in citrulline concentrations over the first week in ICU unlike those not receiving EEN/ON (P = 0.049 for the mean log-citrulline values over time between groups) as well as higher average citrulline concentrations. Success of EEN/ON (80 % of caloric target achieved by day 4) was associated with citrulline values increasing from day 4, whereas a slight decrease was observed with unsuccessful EEN/ON. However, these dynamics over time were not statistically significantly different (P = 0.654). Patients with EEN/ON unexpectedly had I-FABP values higher than those without (average values for all days P = 0.004). Median I-FABP values on day 3 were higher with successful EEN/ON (646 (IQR 313-1116) vs 278 (IQR 190-701) pg/mL, P = 0.022). CONCLUSIONS EEN/ON was associated with higher values and different dynamics of citrulline over the first week in ICU. No clear difference of measured biomarkers was seen when patients were compared according to success of EEN/ON. Our study does not allow suggesting certain thresholds of citrulline nor I-FABP that could be used for bedside decision-making with regard to EN. This study was a planned sub-study of the iSOFA study (ClinicalTrials.gov Identifier: NCT02613000).
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Affiliation(s)
- Martin Padar
- Department of Anaesthesiology and Intensive Care, Tartu University Hospital, L. Puusepa 8, 51014 Tartu, Estonia; Department of Anaesthesiology and Intensive Care, University of Tartu, L. Puusepa 8, 51014 Tartu, Estonia.
| | - Joel Starkopf
- Department of Anaesthesiology and Intensive Care, Tartu University Hospital, L. Puusepa 8, 51014 Tartu, Estonia; Department of Anaesthesiology and Intensive Care, University of Tartu, L. Puusepa 8, 51014 Tartu, Estonia
| | - Liis Starkopf
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, DK-1014 Copenhagen, Denmark
| | - Alastair Forbes
- Norwich Medical School, University of East Anglia, Bob Champion Building, James Watson Road, Norwich, NR4 7UQ, United Kingdom
| | - Michael Hiesmayr
- Division of Cardio-Thoracic-Vascular Surgical Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria. Spitalgasse 23, Wien, 1090, Austria
| | - Stephan M Jakob
- Department of Intensive Care Medicine, University Hospital, University of Bern, Bern, Switzerland
| | - Olav Rooijackers
- Department of Clinical Science, Intervention and Technology, Division of Anaesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jan Wernerman
- Department of Clinical Science, Intervention and Technology, Division of Anaesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sven Erik Ojavee
- Department of Computational Biology, University of Lausanne, 1015 Lausanne, Switzerland
| | - Annika Reintam Blaser
- Department of Anaesthesiology and Intensive Care, University of Tartu, L. Puusepa 8, 51014 Tartu, Estonia; Department of Intensive Care Medicine, Lucerne Cantonal Hospital, 6000 Lucerne, Switzerland
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30
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Xu LC, Huang XJ, Lin BX, Zheng JY, Zhu HH. Clinical nurses' nasogastric feeding practices in adults: a multicenter cross-sectional survey in China. J Int Med Res 2021; 48:300060520920051. [PMID: 32349566 PMCID: PMC7218984 DOI: 10.1177/0300060520920051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE We aimed to investigate practices of nasogastric tube (NGT) intubation and feeding for adults by clinical nurses in China. METHODS A self-designed and validated questionnaire comprising 30 questions was distributed to 560 clinical nurses in three comprehensive hospitals of Xiamen, China. The questionnaire covered participants' demographic characteristics, NGT placement, administration of enteral nutrition (EN), and monitoring or management of feeding intolerance. RESULTS A total 464 (82.9%) questionnaires were completed; 36.2% of nurses used nose-ear-xiphoid and 79.5% forehead-xiphoid measurement to define the internal length of the NGT. Many participants still used traditional methods to confirm NGT placement (auscultation of injected air 50.2%, bubble test 34.7% and observing feeding tube aspirate 34.3%). Bolus feeding was the most commonly used technique to administer EN. A total 97.0% of all nurses used syringes to measure gastric residual volume (GRV), and 62.7% measured GRV every 4-8 hours. The most frequently used GRV threshold values were 200 mL (44.6%) and 150 mL (25.2%). Most nurses stopped feeding immediately when encountering high GRV (84.3%) or diarrhea (45.0%). The nasogastric feeding practices of many clinical nurses were not consistent with international guidelines. CONCLUSIONS Our study can provide an impetus for nursing administrators to revise their nasogastric feeding procedures, to promote compliance with evidence-based guidelines.
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Affiliation(s)
- Li-Chun Xu
- Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China
| | - Xiao-Jin Huang
- Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China
| | - Bi-Xia Lin
- Xiamen Cardiovascular Hospital Xiamen University, Xiamen, Fujian, China
| | - Jun-Yi Zheng
- Nursing Department of Xiamen University, Xiamen, Fujian, China
| | - Hai-Hua Zhu
- The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
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Li Y, Yang J, Sun S, Huang J, Zhang A, Tang X. Effects of intermittent feeding versus continuous feeding on enteral nutrition tolerance in critically ill patients: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e23528. [PMID: 33327299 PMCID: PMC7738118 DOI: 10.1097/md.0000000000023528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 11/06/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Nutritional support is an indispensable treatment for critically ill patients. Enteral nutrition intolerance is one of the obstacles to the smooth progress of enteral nutrition.Enteral nutrition can be divided into continuous feeding and intermittent feeding. However, the effectiveness and safety of the 2 ways of nutrition infusion are controversial clinically. Therefore, this meta-analysis further evaluated the effect of intermittent feeding versus continuous feeding on enteral nutrition tolerance in critically ill patients. METHODS Cochrane Library, PubMed, Web of Science, EMbase, China Biology Medicine disc (CBM), China Science and Technology Journal Database (VIP), China Journal full-text Database (CNKI), and Wanfang Database were searched for all randomized controlled trials (RCTs) on the effects of intermittent and continuous feeding on enteral nutrition tolerance in critically ill patients. The quality of literatures was strictly evaluated and the data were extracted by 2 investigators. Meta-analysis was carried out by applying RevMan 5.5 software. RESULTS The results of this meta-analysis are published in peer-reviewed journals. CONCLUSIONS This study provides reliable evidence-based support for the effects of intermittent and continuous feeding on enteral nutrition tolerance in critically ill patients. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/4BP5X.
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Deane AM, Ali Abdelhamid Y, Plummer MP, Fetterplace K, Moore C, Reintam Blaser A. Are Classic Bedside Exam Findings Required to Initiate Enteral Nutrition in Critically Ill Patients: Emphasis on Bowel Sounds and Abdominal Distension. Nutr Clin Pract 2020; 36:67-75. [PMID: 33296117 DOI: 10.1002/ncp.10610] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 11/05/2020] [Indexed: 02/06/2023] Open
Abstract
The general physical examination of a patient is an axiom of critical care medicine, but evidence to support this practice remains sparse. Given the lack of evidence for a comprehensive physical examination of the entire patient on admission to the intensive care unit, which most clinicians consider an essential part of care, should clinicians continue the practice of a specialized gastrointestinal system physical examination when commencing enteral nutrition in critically ill patients? In this review of literature related to gastrointestinal system examination in critically ill patients, the focus is on gastrointestinal sounds and abdominal distension. There is a summary of what these physical features represent, an evaluation of the evidence regarding use of these physical features in patients after abdominal surgery, exploration of the rationale for and against using the physical findings in routine practice, and detail regarding what is known about each feature in critically ill patients. Based on the available evidence, it is recommended that an isolated symptom, sign, or bedside test does not provide meaningful information. However, it is submitted that a comprehensive physical assessment of the gastrointestinal system still has a role when initiating or administering enteral nutrition: specifically, when multiple features are present, clinicians should consider further investigation or intervention.
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Affiliation(s)
- Adam M Deane
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Melbourne Medical School, Department of Medicine and Radiology, Royal Melbourne Hospital, Parkville, The University of Melbourne, Parkville, Victoria, Australia
| | - Yasmine Ali Abdelhamid
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Melbourne Medical School, Department of Medicine and Radiology, Royal Melbourne Hospital, Parkville, The University of Melbourne, Parkville, Victoria, Australia
| | - Mark P Plummer
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Melbourne Medical School, Department of Medicine and Radiology, Royal Melbourne Hospital, Parkville, The University of Melbourne, Parkville, Victoria, Australia
| | - Kate Fetterplace
- Melbourne Medical School, Department of Medicine and Radiology, Royal Melbourne Hospital, Parkville, The University of Melbourne, Parkville, Victoria, Australia.,Allied Health (Clinical Nutrition), Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Cara Moore
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Annika Reintam Blaser
- Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia.,Department of Intensive Care, Lucerne Cantonal Hospital, Lucerne, Switzerland
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33
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Reintam Blaser A, Deane AM, Preiser J, Arabi YM, Jakob SM. Enteral Feeding Intolerance: Updates in Definitions and Pathophysiology. Nutr Clin Pract 2020; 36:40-49. [DOI: 10.1002/ncp.10599] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Annika Reintam Blaser
- Department of Intensive Care Medicine Lucerne Cantonal Hospital Lucerne Switzerland
- Department of Anaesthesiology and Intensive Care University of Tartu Tartu Estonia
| | - Adam M. Deane
- Department of Medicine and Radiology The University of Melbourne Melbourne Medical School Royal Melbourne Hospital Parkville Victoria Australia
| | | | - Yaseen M. Arabi
- College of Medicine King Saud bin Abdulaziz University for Health Sciences (KSAU‐HS) and King Abdullah International Medical Research Center Riyadh Saudi Arabia
| | - Stephan M. Jakob
- Department of Intensive Care Medicine University Hospital (Inselspital) Bern University of Bern Bern Switzerland
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Huang CT, Hong CM, Tsai YJ, Sheng WH, Yu CJ. Gastrointestinal complications are associated with a poor outcome in non-critically ill pneumonia patients. BMC Gastroenterol 2020; 20:383. [PMID: 33198635 PMCID: PMC7670594 DOI: 10.1186/s12876-020-01537-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/10/2020] [Indexed: 12/15/2022] Open
Abstract
Background Development of gastrointestinal (GI) complications is adversely associated with prognosis in the critically ill. However, little is known about their impact on the outcome of non-critically ill patients. In this study, we aimed to investigate the incidence of GI complications and their influence on prognosis of hospitalized pneumonia patients. Methods Adult patients admitted with a diagnosis of pneumonia from 2012 to 2014 were included. Medical records were reviewed to obtain patients’ demographics, physical signs, comorbidities, laboratory results, clinical events, and the Confusion, Urea, Respiratory rate, Blood pressure and age ≥ 65 (CURB-65) score was calculated to assess the severity of pneumonia. GI complications, including bowel distension, diarrhea, GI bleeding and ileus, were evaluated during the first 3 days of hospitalization and their association with patient outcomes, such as hospital mortality and length of stay, was analyzed. Results A total of 1001 patients were enrolled, with a mean age of 73.7 years and 598 (59%) male. Among them, 114 (11%) patients experienced at least one GI complication and diarrhea (5.2%) was the most common. The hospital mortality was 14% and was independently associated with an increase in the CURB-65 score (odds ratio [OR] 1.952 per point increase; 95% confidence interval [CI] 1.516–2.514), comorbid malignancy (OR 1.943; 95% CI 1.209–3.123), development of septic shock (OR 25.896; 95% CI 8.970–74.765), and the presence of any GI complication (OR 1.753; 95% CI 1.003–3.065). Conclusions Compared to a critical care setting, GI complications are not commonly observed in a non-critical care setting; however, they still have a negative impact on prognosis of pneumonia patients, including higher mortality and prolonged length of hospital stay.
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Affiliation(s)
- Chun-Ta Huang
- Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan. .,Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan.
| | - Chun-Ming Hong
- Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Yi-Ju Tsai
- Graduate Institute of Biomedical and Pharmaceutical Science, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Wang-Huei Sheng
- Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
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Sabino KM, Fuller J, May S, Wakefield D. Safety and Tolerance of Enteral Nutrition in the Medical and Surgical Intensive Care Unit Patient Receiving Vasopressors. Nutr Clin Pract 2020; 36:192-200. [PMID: 32643840 DOI: 10.1002/ncp.10548] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 05/05/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Multiple societal guidelines recommend enteral nutrition (EN) be initiated within 24 to 48 hours of admission to the intensive care unit (ICU) once a patient is hemodynamically stable. Gastrointestinal intolerance and occurrence of bowel ischemia have been a concern for patients receiving vasopressors while concurrently receiving luminal nutrients. The study objective was to determine whether patients receiving vasopressors while concomitantly receiving enteral nutrients had more incidences of bowel ischemia and intolerance than those receiving EN without vasopressor agents. METHODS This retrospective study included 319 medical and surgical ICU patients from a level 1 trauma center. The patients were either receiving vasopressors simultaneously with EN (n = 178) or EN alone (n = 141). Data regarding gastric residual volume (GRV), new abdominal pain, emesis, and bowel ischemia were collected. RESULTS There were more patients who had elevated GRV in the group that received vasopressors than patients who did not (20% vs 7%; P-value < .01). There were no differences between rates of bowel ischemia, emesis, or new abdominal pain between the 2 groups. CONCLUSION Based on our findings, EN is generally well tolerated and safe for those patients simultaneously receiving vasopressors.
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Affiliation(s)
- Kim M Sabino
- Trinity Health Of New England, Saint Francis Hospital and Medical Center, Hartford, Connecticut, 06105, USA
| | - Julie Fuller
- Trinity Health Of New England, Saint Francis Hospital and Medical Center, Hartford, Connecticut, 06105, USA
| | - Scott May
- Trinity Health Of New England, Saint Francis Hospital and Medical Center, Hartford, Connecticut, 06105, USA
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Abstract
PURPOSE OF REVIEW To provide a comprehensive update of diagnosis and treatment of gastrointestinal dysmotility in the critically ill, with a focus on work published in the last 5 years. RECENT FINDINGS Symptoms and clinical features consistent with upper and/or lower gastrointestinal dysmotility occur frequently. Although features of gastrointestinal dysmotility are strongly associated with adverse outcomes, these associations may be because of unmeasured confounders. The use of ultrasonography to identify upper gastrointestinal dysmotility appears promising. Both nonpharmacological and pharmacological approaches to treat gastrointestinal dysmotility have recently been evaluated. These approaches include modification of macronutrient content and administration of promotility drugs, stool softeners or laxatives. Although these approaches may reduce features of gastrointestinal dysmotility, none have translated to patient-centred benefit. SUMMARY 'Off-label' metoclopramide and/or erythromycin administration are effective for upper gastrointestinal dysmotility but have adverse effects. Trials of alternative or novel promotility drugs have not demonstrated superiority over current pharmacotherapies. Prophylactic laxative regimens to prevent non-defecation have been infrequently studied and there is no recent evidence to further inform treatment of established pseudo-obstruction. Further trials of nonpharmacological and pharmacological therapies to treat upper and lower gastrointestinal dysmotility are required and challenges in designing such trials are explored.
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Chapman MJ, Jones KL, Almansa C, Barnes CN, Nguyen D, Deane AM. Blinded, Double-Dummy, Parallel-Group, Phase 2a Randomized Clinical Trial to Evaluate the Efficacy and Safety of a Highly Selective 5-Hydroxytryptamine Type 4 Receptor Agonist in Critically Ill Patients With Enteral Feeding Intolerance. JPEN J Parenter Enteral Nutr 2020; 45:115-124. [PMID: 31990087 PMCID: PMC7891369 DOI: 10.1002/jpen.1732] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 09/23/2019] [Accepted: 10/05/2019] [Indexed: 12/22/2022]
Abstract
Background Delayed gastric emptying is the leading cause of enteral feeding intolerance (EFI) in critical illness. This phase 2a study compared TAK‐954, a selective agonist of 5‐hydroxytryptamine type 4 receptors, with metoclopramide in critically ill patients with EFI (NCT01953081). Methods A blinded, double‐dummy trial was conducted in mechanically ventilated patients with EFI (>200 mL gastric residual volume within 24 hours before randomization). Patients were randomized to receive either 0.5 mg intravenous TAK‐954 over 1 hour then 0.9% saline injection 4 times/d (sham metoclopramide) or the active comparator 10 mg intravenous metoclopramide 4 times/d and a 1‐hour 0.9% saline infusion. After initial dosing, participants received a radiolabeled meal of liquid nutrient (Ensure; 106 kcal), and gastric emptying was measured (scintigraphy). Adverse events (AEs) were recorded from the time of consent through to day 5; serious AEs were collected to day 30. Results Thirteen patients (TAK‐954, n = 7; metoclopramide, n = 6) participated. Five patients in the TAK‐954 group and 4 in the metoclopramide group experienced AEs (2 and 3, respectively, were serious). All AEs except 1 (diarrhea in the metoclopramide group) were considered unrelated to study drug. Following treatment, a greater proportion of patients receiving TAK‐954 had normal gastric retention (<13% retention at 180 minutes) than those receiving metoclopramide (6/7 vs 3/6 patients, respectively). Conclusion A single dose of 0.5 mg intravenous TAK‐954 appears to have at least similar efficacy in accelerating gastric emptying to multiple doses of 10 mg metoclopramide and was not associated with increased AEs.
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Affiliation(s)
- Marianne J Chapman
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia, Australia.,Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Karen L Jones
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Cristina Almansa
- Takeda Development Center Americas, Inc., Cambridge, Massachusetts, USA
| | - Chris N Barnes
- Theravance Biopharma US, Inc., South San Francisco, California, USA
| | - Deanna Nguyen
- Theravance Biopharma US, Inc., South San Francisco, California, USA
| | - Adam M Deane
- Intensive Care Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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38
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Bruen T, Rawal S, Tomesko J, Byham-Gray L. Elimination of Routine Gastric Residual Volume Monitoring Improves Patient Outcomes in Adult Critically Ill Patients in a Community Hospital Setting. Nutr Clin Pract 2020; 35:522-532. [PMID: 31990098 DOI: 10.1002/ncp.10442] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND A community hospital updated its nutrition support practices in 2016 through the elimination of monitoring gastric residual volume (GRV) in accordance with the 2016 Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. METHODS This retrospective analysis (N = 61) compared incidence of feeding intolerance in 2 cohorts of adult critically ill patients pre-implementation (n = 36) and post-implementation (n = 25) of these guidelines into a nutrition support team's standard of practice policy. Differences in kilocalories and protein (gm) received and percent of daily prescribed kilocalories and protein received were also compared between the 2 cohorts. RESULTS Mean episodes of gastrointestinal intolerance over the number of eligible days of receiving enteral nutrition in the critical care unit did not differ between the pre-implementation and post-implementation groups (P = 0.46). Compared with the pre-implementation group, the post-guideline implementation cohort was significantly more likely to meet higher percentages of both prescribed protein (71.8 ± 22.2% vs 55.9 ± 24.0%; P = 0.01) and energy requirements (93.4 ± 36.9% vs 69.6 ± 35.3%; P = 0.01), even after adjusting for potential confounders (age, body mass index, sex, and primary comorbid medical condition). CONCLUSION Elimination of routine monitoring of GRV may result in a greater percentage of prescribed daily nutrient requirements met by patients in the critical care setting, without adverse effects on feeding intolerance.
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Affiliation(s)
- Tracy Bruen
- Nutritional Services Williamson Medical Center, School of Health Professions, Franklin, Tennessee, USA.,Department of Clinical and Preventive Nutrition Sciences, Rutgers University, New Brunswick, New Jersey, USA
| | - Shristi Rawal
- Department of Clinical and Preventive Nutrition Sciences, Rutgers University, New Brunswick, New Jersey, USA
| | - Jennifer Tomesko
- Department of Clinical and Preventive Nutrition Sciences, Rutgers University, New Brunswick, New Jersey, USA
| | - Laura Byham-Gray
- Department of Clinical and Preventive Nutrition Sciences, Rutgers University, New Brunswick, New Jersey, USA
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McClave SA, Gualdoni J, Nagengast A, Marsano LS, Bandy K, Martindale RG. Gastrointestinal Dysfunction and Feeding Intolerance in Critical Illness: Do We Need an Objective Scoring System? Curr Gastroenterol Rep 2020; 22:1. [PMID: 31912312 DOI: 10.1007/s11894-019-0736-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE OF REVIEW Efforts to provide early enteral nutrition in critical illness are thwarted by gastrointestinal dysfunction and feeding intolerance. While many of the signs and symptoms of this dysfunction reflect gastroparesis and intestinal dysmotility, other symptoms which may or may not be related are often included such as diarrhea, bleeding, and intra-abdominal hypertension. This paper discusses the need to monitor tolerance of nutritional therapy in the critical care setting and reviews the results of those clinical trials which have helped establish objective measures, define feeding intolerance, and provide a tool to guide continued delivery of the enteral regimen. RECENT FINDINGS While definitions vary, the presence of gastrointestinal dysfunction and feeding intolerance correlates with adverse clinical outcomes, including prolonged duration of mechanical ventilation, greater length of stay in the intensive care unit, and increased mortality. Despite their prognostic value, it is not clear to what extent these scoring systems should direct nutritional therapy. The clinician should be astute in the careful selection of monitors, in identifying and addressing signs and symptoms of intolerance, and by responding appropriately with feeding strategies that are effective and safe. Early enteral feeding in critical illness has been shown to be optimized by following protocols which allow monitoring patient tolerance while providing individualized care.
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Affiliation(s)
- Stephen A McClave
- Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA.
- Division of Gastroenterology, Hepatology & Nutrition, University of Louisville School of Medicine, 550 South Jackson Street, Louisville, KY, 40202, USA.
| | - Jill Gualdoni
- Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Annie Nagengast
- Department of Surgery, Oregon Health Sciences University, Portland, OR, USA
| | - Luis S Marsano
- Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Kathryn Bandy
- Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
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Blaser AR, Montejo González JC, Alhazzani W, Singer P. Reply-Letter to the Editor-The efficacy and safety of administration of prokinetics improve clinical outcomes in critically ill patients is still quite unclear from Dr Peng. Clin Nutr 2019; 39:606-607. [PMID: 31839433 DOI: 10.1016/j.clnu.2019.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 11/15/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Annika Reitam Blaser
- Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia and Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | | | - Waleed Alhazzani
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Pierre Singer
- Department of General Intensive Care, Institute for Nutrition Research, Rabin Medical Center, Tel Aviv University, Israel.
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Peng J, Liu GW, Li F, Yuan M, Xiang Y, Qin D. The correlation between feeding intolerance and poor prognosis of patients with severe neurological conditions: a case-control study. Expert Rev Neurother 2019; 19:1265-1270. [PMID: 31601136 DOI: 10.1080/14737175.2019.1679627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background: This study aims to investigate the current status of feeding intolerance (FI) among patients with severe neurological conditions and to further determine the correlation between FI and their poor prognosis.Methods: This study performed a retrospective analysis of the medical data of 58 patients from January 2017 to December 2017. Patients were divided into two groups according to modified Rankin Scale (mRS) scores. Logistic regression was used to analyze the relevant factors for the poor prognosis of these patients.Results: General data analysis showed that age and diagnosis(stroke) were significantly different between the two groups (P < 0.05). Univariate analysis showed that APACHE II score, vomiting within 3 days of NICU admission, gastrointestinal bleeding within 3 days of NICU admission and occurrence of FI within 3 days of NICU admission were all risk factors for a poor prognosis of these patients(P < 0.05). Multivariate logistic regression analysis showed that FI within 3 days of NICU admission(OR 8.026, 95%CI(1.550-26.039)) and diagnosis(stroke)(OR 10.654, 95%CI (1.746-21.291)) were independent factors for a poor prognosis of patients with severe neurological conditions.Conclusion: The incidence of early FI in stroke patients is correlated with a poor prognosis.
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Affiliation(s)
- Jingjing Peng
- Department of Neurosurgery, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Guang-Wei Liu
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Feng Li
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Meizhen Yuan
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Yanling Xiang
- Department of Operation Anesthesia, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Deyu Qin
- Department of Infectious, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
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Aperstein Y, Cohen L, Bendavid I, Cohen J, Grozovsky E, Rotem T, Singer P. Improved ICU mortality prediction based on SOFA scores and gastrointestinal parameters. PLoS One 2019; 14:e0222599. [PMID: 31568512 PMCID: PMC6768479 DOI: 10.1371/journal.pone.0222599] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 09/02/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The Sequential Organ Failure Assessment (SOFA) score is commonly used in ICUs around the world, designed to assess the severity of the patient's clinical state based on function/dysfunction of six major organ systems. The goal of this work is to build a computational model to predict mortality based on a series of SOFA scores. In addition, we examined the possibility of improving the prediction by incorporating a new component designed to measure the performance of the gastrointestinal system, added to the other six components. METHODS In this retrospective study, we used patients' three latest SOFA scores recorded during an individual ICU stay as input to different machine learning models and ensemble learning models. We added three validated parameters representing gastrointestinal failure. Among others, we used classification models such as Support Vector Machines (SVMs), Neural Networks, Logistic Regression and a penalty function used to increase model robustness in regard to certain extreme cases, which may be found in ICU population. We used the Area under Curve (AUC) performance metric to examine performance. RESULTS We found an ensemble model of linear and logistic regression achieves a higher AUC compared related works in past years. After incorporating the gastrointestinal failure score along with the penalty function, our best performing ensemble model resulted in an additional improvement in terms of AUC metrics. We implemented and compared 36 different models that were built using both the information from the SOFA score as well as that of the gastrointestinal system. All compared models have approximately similar and relatively large AUC (between 0.8645 and 0.9146) with the best results are achieved by incorporating the gastrointestinal parameters into the prediction models. CONCLUSIONS Our findings indicate that gastrointestinal parameters carry significant information as a mortality predictor in addition to the conventional SOFA score. This information improves the predictive power of machine learning models by extending the SOFA to include information related to gastrointestinal organ system. The described method improves mortality prediction by considering the dynamics of the extended SOFA score. Although tested on a limited data set, the results' stability across different models suggests robustness in real-time use.
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Affiliation(s)
- Yehudit Aperstein
- Department of Industrial Engineering and Management, Afeka Academic College of Engineering, Tel Aviv, Israel
| | - Lidor Cohen
- Department of Industrial Engineering and Management, Afeka Academic College of Engineering, Tel Aviv, Israel
| | - Itai Bendavid
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- * E-mail:
| | - Jonathan Cohen
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Elad Grozovsky
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Tammy Rotem
- Department of Industrial Engineering and Management, Afeka Academic College of Engineering, Tel Aviv, Israel
| | - Pierre Singer
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
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Hu B, Sun R, Wu A, Ni Y, Liu J, Guo F, Ying L, Ge G, Ding A, Shi Y, Liu C, Xu L, Jiang R, Lu J, Lin R, Zhu Y, Wu W, Xie B. Prognostic Value of Prolonged Feeding Intolerance in Predicting All-Cause Mortality in Critically Ill Patients: A Multicenter, Prospective, Observational Study. JPEN J Parenter Enteral Nutr 2019; 44:855-865. [PMID: 31429970 DOI: 10.1002/jpen.1693] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 06/27/2019] [Accepted: 07/17/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND The 2012 European Society of Intensive Care Medicine (ESICM) guidelines provided a clear definition of feeding intolerance (FI). The study aimed to investigate the association between FI based on the current ESICM definition and clinical outcome and to further explore the effect of the duration of FI on mortality. METHODS Adult patients from 14 general intensive care units (ICUs) with an expected ICU stay ≥24 hours were prospectively studied. Based on FI duration in the first week of admission to the ICU, FI was categorized as 7-day persistent feeding tolerance (FT), delayed FT, delayed FI, and 7-day persistent FI. The primary outcomes were 28-day and 60-day all-cause mortality. RESULTS Of 499 patients, the prevalence of 3-day and 7-day persistent FI was 39.2% (n = 196) and 25.4% (n = 106), respectively. The patients with 3-day FT had lower risk of 28-day and 60-day mortality rates and higher prevalence in ventilator weaning and vasoactive medication on the seventh day of ICU admission than those with 3-day FI. Three-day FI remained an independent predictor for 60-day mortality. In a subgroup analysis including 418 patients with 7-day survival, compared with those with 7-day persistent FT, the odds ratios of 60-day mortality were 1.67, 1.97, and 2.62 in the patients with delayed FT, delayed FI, and 7-day persistent FI, respectively. CONCLUSION FI was associated with increased mortality and longer duration of mechanical ventilation and vasoactive support. Prolonged or relapsing FI represented an incremental risk of adverse outcomes in critically ill patients.
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Affiliation(s)
- Bangchuan Hu
- ICU, Zhejiang Provincial People's Hospital, Hangzhou, P. R. China
| | - Renhua Sun
- ICU, Zhejiang Provincial People's Hospital, Hangzhou, P. R. China
| | - Aiping Wu
- ICU, Zhejiang Provincial People's Hospital, Hangzhou, P. R. China
| | - Yin Ni
- ICU, Zhejiang Provincial People's Hospital, Hangzhou, P. R. China
| | - Jingquan Liu
- ICU, Zhejiang Provincial People's Hospital, Hangzhou, P. R. China
| | - Feng Guo
- ICU, Sir Run Shaw Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, P. R. China
| | - Lijun Ying
- ICU, Shaoxing People's Hospital, Shaoxing, P. R. China
| | - Guoping Ge
- ICU, Jinhua People's Hospital, Jinhua, P. R. China
| | - Aijun Ding
- ICU, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, P. R. China
| | - Yunchao Shi
- ICU, The First Hospital of Jiaxing, Jiaxing, P. R. China
| | - Changwen Liu
- ICU, Hangzhou First People's Hospital, Hangzhou, P. R. China
| | - Lei Xu
- ICU, Ningbo Medical Treatment Center Lihuili Hospital, Ningbo, P. R. China
| | - Ronglin Jiang
- ICU, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, P. R. China
| | - Jun Lu
- ICU, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, P. R. China
| | - Ronghai Lin
- ICU, Taizhou Hospital of Zhejiang Province, Linhai, P. R. China
| | - Yannan Zhu
- ICU, Zhuji People's Hospital of Zhejiang Province, Shaoxing, P. R. China
| | - Weidong Wu
- ICU, The Central Hospital of Lishui City, Lishui, P. R. China
| | - Bo Xie
- ICU, Huzhou Central Hospital, Huzhou, P. R. China
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Hay T, Deane AM, Rechnitzer T, Fetterplace K, Reilly R, Ankravs M, Bailey M, Fazio T, Anstey J, D’Costa R, Presneill JJ, MacIsaac CM, Bellomo R. The hospital-based evaluation of laxative prophylaxis in ICU (HELP-ICU): A pilot cluster-crossover randomized clinical trial. J Crit Care 2019; 52:86-91. [DOI: 10.1016/j.jcrc.2019.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 04/04/2019] [Accepted: 04/05/2019] [Indexed: 12/19/2022]
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Asrani VM, Brown A, Huang W, Bissett I, Windsor JA. Gastrointestinal Dysfunction in Critical Illness: A Review of Scoring Tools. JPEN J Parenter Enteral Nutr 2019; 44:182-196. [PMID: 31350771 DOI: 10.1002/jpen.1679] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Varsha M. Asrani
- Department of Surgery School of Medicine Faculty of Medical and Health Sciences, University of Auckland Auckland New Zealand
- Department of Nutrition and Dietetics Auckland City Hospital Auckland New Zealand
| | - Annabelle Brown
- Discipline of Nutrition and Dietetics Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand
| | - Wei Huang
- Department of Integrated Traditional Chinese and Western Medicine Sichuan Provincial Pancreatitis Centre West China Hospital of Sichuan University Chengdu China
| | - Ian Bissett
- Department of Surgery School of Medicine Faculty of Medical and Health Sciences, University of Auckland Auckland New Zealand
- Department of General Surgery Auckland City Hospital Auckland New Zealand
| | - John A. Windsor
- Department of Surgery School of Medicine Faculty of Medical and Health Sciences, University of Auckland Auckland New Zealand
- Department of General Surgery Auckland City Hospital Auckland New Zealand
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Marino LV, Eveleens RD, Morton K, Verbruggen SCAT, Joosten KFM. Peptide nutrient-energy dense enteral feeding in critically ill infants: an observational study. J Hum Nutr Diet 2019; 32:400-408. [PMID: 30848864 DOI: 10.1111/jhn.12645] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Enteral feeding is challenging in critically ill infants. Target intakes are often not achieved as a result of fluid restriction, procedural interruptions and perceived enteral feeding intolerance. In those infants perceived to have poor feeding tolerance, the use of a peptide nutrient-energy dense enteral feed (PEF) may improve nutritional intake and minimise feeding interruptions as a result of gastrointestinal symptoms. The aim of this observational study was to characterise the use of a PEF amongst critically ill infants in two paediatric intensive care units (PICUs). METHODS Records from critically ill infants aged <12 months admitted to two PICUs were retrospectively reviewed with a PICU length of stay (LOS) ≥ 7 days. Achievement of nutritional targets for the duration of PEF was reviewed. Gastrointestinal symptoms, including gastric residual volume, constipation and vomiting, were evaluated as tolerance parameters. RESULTS In total, 53 infants were included, with a median age on admission of 2.6 months. Median admission weight was 3.9 kg in PICU-1 and 4.7 kg in PICU-2. Median (interquatile range) energy intake in PICU-1 and PICU-2 was 68 (47-92) and 90 (63-124) kcal kg-1 , respectively, and median (interquatile range) protein intake 1.7 (1.1-2.4) g kg-1 and 2.5 (1.6-3.2) g kg-1 , respectively. Feeding was withheld because of feeding intolerance in one infant (4%) on two occasions in PICU-1 for 2.5 h and in two infants (7%) on two occasions in PICU-2 for 19.5 h. Gastric residual mean (SD) volumes were 3.5 (5.4) mL kg-1 in PICU-1 and 16.9 (15.6) mL kg-1 in PICU-2. CONCLUSIONS Peptide nutrient-energy dense feeding in infants admitted to the PICU is feasible, well tolerated and nutritional targets are met. However, with this study design, it is not possible to draw any conclusions regarding the benefit of PEF over standard PE feed in critically ill children and future work is required to clarify this further.
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Affiliation(s)
- L V Marino
- Department of Dietetics and Speech & Language Therapy, University of Southampton, Southampton, UK.,NIHR Biomedical Research Centre Southampton, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK.,Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - R D Eveleens
- Intensive Care Unit, Department of Paediatrics and Paediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - K Morton
- Faculty of Health Sciences, University of Southampton, Southampton, UK.,Paediatric Intensive Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - S C A T Verbruggen
- Intensive Care Unit, Department of Paediatrics and Paediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - K F M Joosten
- Intensive Care Unit, Department of Paediatrics and Paediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
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Hay T, Bellomo R, Rechnitzer T, See E, Ali Abdelhamid Y, Deane AM. Constipation, diarrhea, and prophylactic laxative bowel regimens in the critically ill: A systematic review and meta-analysis. J Crit Care 2019; 52:242-250. [PMID: 30665795 DOI: 10.1016/j.jcrc.2019.01.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/24/2018] [Accepted: 01/08/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Prophylactic laxative bowel regimens may prevent constipation in enterally-fed critically ill patients. However, their use may also increase diarrhea. We performed a systematic review to: 1. Explore the epidemiology of constipation and/or diarrhea in critically ill patients; and 2. Appraise trials evaluating prophylactic laxative bowel regimens. METHODS We searched MEDLINE, Embase, and CINAHL for publications that reported constipation or diarrhea in critically ill adult patients and/or prophylactic laxative bowel regimens. RESULTS The proportion of critically ill patients experiencing constipation was reported between 20% and 83% and the proportion experiencing diarrhea was reported between 3.3% and 78%. Six studies of prophylactic laxative bowel regimens were identified but only 3 randomised controlled trials were identified, and these were subjected to meta-analysis. Compared with placebo, a prophylactic laxative bowel regimen increased the risk of diarrhea (RR 1.58, 95% CI 1.22 to 2.04) but did not reduce the risk of constipation (RR 0.39, 95% CI 0.14 to 1.05), and did not affect the duration of mechanical ventilation, duration of ICU admission, or mortality. CONCLUSIONS Constipation and diarrhea occur frequently in the critically ill but data evaluating prophylactic laxative bowel regimens in such patients are sparse and do not support their use.
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Affiliation(s)
- Tyler Hay
- The University of Melbourne, Melbourne Medical School, Parkville, Victoria, Australia
| | - Rinaldo Bellomo
- The University of Melbourne, Melbourne Medical School, Department of Medicine and Radiology, Royal Melbourne Hospital, Parkville, VIC 3050, Australia; Intensive Care Unit, The Austin Hospital, Heidelberg, Victoria, Australia; Intensive Care Unit, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Tom Rechnitzer
- Intensive Care Unit, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Emily See
- Intensive Care Unit, The Austin Hospital, Heidelberg, Victoria, Australia
| | | | - Adam M Deane
- The University of Melbourne, Melbourne Medical School, Department of Medicine and Radiology, Royal Melbourne Hospital, Parkville, VIC 3050, Australia; Intensive Care Unit, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
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Orinovsky I, Raizman E. Improvement of Nutritional Intake in Intensive Care Unit Patients via a Nurse-Led Enteral Nutrition Feeding Protocol. Crit Care Nurse 2018; 38:38-44. [PMID: 29858194 DOI: 10.4037/ccn2018433] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Enteral nutrition in intensive care unit patients has important prognostic clinical value. Feeding protocols are recommended by clinical practice guidelines as a key strategy to maximize the benefits and minimize the risks of enteral feedings. OBJECTIVE To examine whether enteral nutrition in critically ill patients could be improved by implementation of a nurse-led evidence-based feeding protocol. METHODS An interprofessional group of intensive care unit nurses, physicians, and a clinical dietitian designed a protocol to address and correct the shortcomings of enteral feeding. Data on feeding and clinical outcomes were collected retrospectively for patients for 12 months before (control group) and then for 12 months after (interventional group) implementation of the protocol. RESULTS Enteral feeding was started significantly earlier (P = .007) after admission to the intensive care unit in the intervention group (52.3 hours; SD, 42.6) than in the control group (70.3 hours; SD, 65.2). Use of the protocol resulted in a significant increase in nutritional intake; 90% of patients in the intervention group but only 34% in the traditional feeding group achieved their caloric target within 96 hours after admission (P < .001). After implementation of the protocol, cessation of feeding due to intolerance was significantly less (P = .03) in the intervention group (6%) than in the traditional feeding group (14 %), and no adverse events were detected. CONCLUSIONS Adherence to standardized guidelines with a written protocol for an early start and timely escalation of enteral feeding can improve nutritional intake among intensive care unit patients.
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Affiliation(s)
- Ira Orinovsky
- Ira Orinovsky is head nurse, Internal Medicine Department, Hadassah Mt. Scopus University Hospital, Jerusalem, Israel.,Ela Raizman is an academic consultant, Nursing Division, Hadassah Mt. Scopus University Hospital
| | - Ela Raizman
- Ira Orinovsky is head nurse, Internal Medicine Department, Hadassah Mt. Scopus University Hospital, Jerusalem, Israel. .,Ela Raizman is an academic consultant, Nursing Division, Hadassah Mt. Scopus University Hospital.
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Eveleens RD, Dungen DK, Verbruggen SCAT, Hulst JM, Joosten KFM. Weight improvement with the use of protein and energy enriched nutritional formula in infants with a prolonged PICU stay. J Hum Nutr Diet 2018; 32:3-10. [PMID: 30318663 DOI: 10.1111/jhn.12603] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Reaching an optimal nutritional intake is challenging in critically ill infants. One possible way to minimise nutritional deficits is the use of protein and energy-enriched (PE)-formulas. We aimed to describe weight achievement and gastrointestinal symptoms in infants admitted to the paediatric intensive care unit (PICU) while receiving PE-formula for a prolonged period. METHODS Records from infants admitted to a multidisciplinary PICU and using PE-formula were analysed retrospectively. Infants were eligible if they received PE-formula daily for at least 2 weeks. Weight achievement was determined as the difference between weight-for-age (WFA) Z-scores at the start and end of PE-formula use. Gastrointestinal symptoms, including gastric residual volume, constipation and vomiting, were evaluated as tolerance parameters. RESULTS Seventy infants with a median [interquartile range (IQR)] age of 76 (30-182) days were eligible. The PICU duration was 50 (35-83) days during which they received PE-formula for 30 (21-54) days. Predominant admission diagnoses were post-cardiac surgery, respiratory and cardiac diagnosis. A significant mean (SD) WFA Z-score increase of 0.48 (1.10) (P < 0.001) and a median (IQR) weight gain of 5.80 (3.28-9.04) g kg-1 day-1 was observed. Multivariate regression showed that a lower WFA Z-score at start was associated with a higher WFA Z-score increase during PE-formula use (β -0.35 (95% confidence interval = -0.50 to -0.19); P < 0.001). The maximum 24-h gastric residual volume was 8.1 mL (IQR = 2.2-14.3) for each 1 kg in bodyweight. Three (4%) infants were treated for diarrhoea and three infants were treated for vomiting. CONCLUSIONS The majority of infants with a prolonged PICU stay showed weight improvement when using PE-formula. PE-formula was well tolerated because gastrointestinal symptoms only occurred in few infants.
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Affiliation(s)
- R D Eveleens
- Department of Paediatrics and Paediatric Surgery, Intensive Care Unit, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - D K Dungen
- Department of Paediatrics and Paediatric Surgery, Intensive Care Unit, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - S C A T Verbruggen
- Department of Paediatrics and Paediatric Surgery, Intensive Care Unit, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J M Hulst
- Division of Paediatric Gastroenterology, Department of Paediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - K F M Joosten
- Department of Paediatrics and Paediatric Surgery, Intensive Care Unit, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
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